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

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

a Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan

b Research Fellow of the Japan Society for the Promotion of Science, Japan

c Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, Japan

d Department of Cardiovascular Medicine, University of Tokyo Hospital, Japan

e Department of Health Services Management and Policy, Graduate School of Medicine Sciences, Kyushu University, Japan

f Department of Pathology and Clinical Cytology, Mitsubishi Chemical Medience, Japan

Corresponding author. Tel.: +81 3 5841 3367; fax: +81 3 5841 3366.

PII: S0379-0738(09)00365-X

doi:10.1016/j.forsciint.2009.09.003

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