Toad Toxicity Associated with Digoxin-Like Bufotoxins

 

Toad species implicated:

(1) Bufo melanosticus

(2) Bufo bufo gargarizans Cantor

(3) Bufo marinus

 

Chinese traditional medicines that may contain these bufotoxins:

(1) chu an wu

(2) yixin wan

(3) kyushin

(4) Chan-su (dried venom)

(5) aphrodisiacs

 

Any implicated substances should be retained for toxicologic analysis.

 

Clinical findings:

(1) atrioventicular node conduction dysfunction (heart block, etc.)

(2) bradycardia

(3) ventricular tachycardia or fibrillation

(4) nausea and vomiting

(5) abdominal discomfort

(6) diaphoresis

(7) disoriented

(8) lethargy

(9) sudden death

 

Management recommendations (after Gowda et al):

(1) Measure serum potassium and digoxin concentrations.

(2) Admit to the ICU and continuously monitor the ECG.

(3) Treat with specific Fab fragments against digoxin.

(4) Do not administer calcium for hyperkalemia.