Autopsy report on central pontine myelinolysis triggered by vomiting associated with digoxin intoxication

Unuma, Kana; Harada, Kazuki; Nakajima, Makoto; Eguchi, Hiromi; Tsushima, Kensuke; Ito, Takako; Shintani-Ishida, Kaori; Kojima, Hideaki; Yoshida, Ken-ichi

doi:10.1016/j.forsciint.2009.09.003

« Previous Next »Forensic Science International
Volume 194, Issue 1 , Pages e5-e8, 30 January 2010

Autopsy report on central pontine myelinolysis triggered by vomiting associated with digoxin intoxication

Kana Unuma
- Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
- Research Fellow of the Japan Society for the Promotion of Science, Japan
Kazuki Harada
- Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
Makoto Nakajima
- Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
Hiromi Eguchi
- Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, Japan
Kensuke Tsushima
- Department of Cardiovascular Medicine, University of Tokyo Hospital, Japan
Takako Ito
- Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
- Department of Health Services Management and Policy, Graduate School of Medicine Sciences, Kyushu University, Japan
Kaori Shintani-Ishida
- Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
Hideaki Kojima
- Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, Japan
- Department of Pathology and Clinical Cytology, Mitsubishi Chemical Medience, Japan
Ken-ichi Yoshida
- Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
- Corresponding author. Tel.: +81 3 5841 3367; fax: +81 3 5841 3366.

Received 26 September 2008; received in revised form 21 April 2009; accepted 1 September 2009. published online 28 September 2009.

Abstract

An 87-year-old male, prescribed digoxin and furosemide for congestive heart failure and Alzheimer disease, had dehydration and anemia due to poor food intake and hemorrhagic cystitis. Repeated vomiting due to an upper respiratory infection caused disturbance of consciousness and hypotension. The patient was admitted to hospital and diagnosed with digoxin intoxication and hypernatremia. The serum sodium (Na⁺) level was corrected, but the patient died 4 days after admission following uncontrollable seizure. A histologic examination after an autopsy revealed characteristic findings of central pontine myelinolysis (CPM). This is the first autopsy report on CPM triggered by vomiting in association with digoxin administration.

Keywords: Central pontine myelinolysis, Digoxin, Vomiting, Autopsy