Q: What are the potential treatment options for Digoxin's Non-Occlusive Mesenteric Ischemia?


Answer: Digoxin (cardiac glycosides) has shown to cause contraction of vascular smooth muscles, particularly arteriolar vessels. Studies have demonstrated that rapid IV push of digoxin may causes constriction of the splanchnic bed. This effect may get enhanced in the presence of hypokalemia, so inhibition of the Na+-K+-ATPase is suspected as underlying mechanism. As digoxin has slow elimination (not cleared by dialysis either), infusion of papaverine (vasodilator) under angiography guide is recommended as a treatment. Another, relatively simple antidote described is glucagon, which is known to  decrease mesenteric vascular resistance. Similarly, diltiazem is also recommended as a treatment.



References:

1. Bynum TE, Hanley HG (1982) Effect of digitalis on estimated splanchnic blood flow. J Lab Clin Med 99:84–91 

2. Ferrer MI, Bradley SE, Wheeler HO, Enson Y, Presig R, Harvey RM (1965) The effect of digoxin in the splanchnic circulation in ventricular failure. Circulation 32:524–537

3. Hess T, Scholtysik G, Salzmann R, Riesen W (1983) Digoxin-specific antibody fragments and a calcium antagonist for reversal of digoxin-induced mesenteric vasoconstriction. J Pharm Pharmacol 35:647–651 

4. Levinsky RA, Lewis RM, Bynum TE, Hanley HG (1975) Digoxin induced intestinal vasoconstriction. The effects of proximal arterial stenosis and glucagon administration. Circulation 52:130–136 

5. Gasic S, Korn A, Eichler HG (1987), Diltiazem counteracts digitalis-dependent splanchnic vasoconstriction in man. Int J Clin Pharmacol Ther Toxicol 25:553–557