REVERSIBLE THROMBOCYTOPENIA IN DIGITOXIN OVERDOSAGE

A 65-year-old woman, known to have peptic ulcers, developed nausea and retching. Clinical examination demonstrated pain on pressure in the e pigastrium with otherwise normative findings for age. Two gastric ulce rs and gastritis with erosions were seen at endoscopy. The patient, wh o was being treated with digitoxin for heart failure, reported having taken up to four digitoxin tablets (0.07 mg each) daily because she ha d insomnia. The plasma digitoxin level was between 150 and 160 nmol/l (therapeutic range 17-33 nmol/l), while the ECG showed no signs of dig italis intoxication. Initially the platelet count was 40 000/mu l: the re had been no history of thrombocytopenia or symptoms of abnormal hae mostasis. Other laboratory tests were within normal Limits. After digi toxin had been discontinued, the platelet count rose without further t reatment to 373 000/mu l 3 weeks after hospital admission by which tim e the digitoxin level had fallen to 48.9 nmol/l. The gastrointestinal symptoms regressed completely on treatment with omeprazole (40 mg thre e times daily for 8 days) and ranitidine (150 mg twice daily).