Editing Digitalis (section)

==Toxicity==
{{Main|Digoxin poisoning}}
[[Image:Digitalis purpurea Koehler drawing.jpg|thumb|right|''Digitalis purpurea'' drawings by [[Köhler's Medicinal Plants|Franz Köhler]]]]

Depending on the species, the digitalis plant may contain several deadly physiological and chemically related cardiac and steroidal glycosides. Thus, the digitalis plants have earned several, more sinister, names: dead man's bells and witch's gloves. The toxins can be absorbed via the skin<ref>{{Cite web|title=GRECIAN FOXGLOVE|url=https://www.mda.state.mn.us/plants/pestmanagement/weedcontrol/noxiouslist/foxglove|access-date=2021-07-01|publisher=Minnesota Department of Agriculture|language=en-us}}</ref> or ingestion.

Digitalis intoxication, known as ''digitalism'', results from an overdose of digitalis and can cause gastrointestinal, cardiac and neurological effects. The former include appetite loss, nausea, vomiting and diarrhoea; the cardiac symptoms include both [[tachycardia]], and [[bradycardia]] (either of which, if severe enough, can result in [[Syncope (medicine)|syncope]]—see below); and the neurological effects include fatigue, delirium, and rarely [[xanthopsia]] (jaundiced or yellow vision).<ref name=Lewis1998>{{cite book |last=Lewis |first=Robert Alan |title= Lewis Dictionary of Toxicology |date=1998 |page=387 |publisher=CRC Press |isbn=978-1-56670-223-2 |quote=Symptoms may include gastrointestinal disturbances and pain, severe headache, nausea, vomiting, diarrhea, irregular pulse, and yellow vision... }}</ref><ref>{{cite web |title=Digoxin Toxicity |url=https://www.rcemlearning.co.uk/foamed/digoxin-toxicity-2/ |website=RCEMLearning |access-date=20 February 2023}}</ref><ref>{{cite journal |last1=Renard |first1=D |last2=Rubli |first2=E |last3=Voide |first3=N |last4=Borruat |first4=FX |last5=Rothuizen |first5=LE |title=Spectrum of digoxin-induced ocular toxicity: a case report and literature review. |journal=BMC Research Notes |date=23 August 2015 |volume=8 |pages=368 |doi=10.1186/s13104-015-1367-6 |pmid=26298392 |pmc=4546820 |doi-access=free }}</ref> Other oculotoxic effects of digitalis include generalized blurry vision, as well as the appearance of blurred outlines ('halos').<ref>{{ cite book |last1=Goldfrank |first1=L. W. | title = Goldfrank's Toxicologic Emergencies | edition = 8th | location = New York | publisher = McGraw-Hill | year = 2006 }}</ref> Other things mentioned are dilated pupils, drooling, weakness, collapse, seizures, and even death.

Digitalis poisoning can cause indirect inhibition of the [[atrioventricular node]] via a direct effect on the [[Dorsal nucleus of vagus nerve|vagal nucleus]]. This results in [[bradycardia]] (decreased heart rate) or if severe enough, [[heart block]]. The direct effect of [[cardiac glycoside]]s on heart muscle cells is to increase contraction of the cells, both in force and frequency, tending to produce [[tachycardia]] (increased heart rate), depending on the dose, the condition of one's heart, and the prevailing chemistry of the blood (specifically any of: low potassium, high calcium and low magnesium).<ref>{{cite journal |last1=Rehman |first1=Rameez |last2=Dawson |first2=Andrew H. |last3=Hai |first3=Ofek |title=Digitalis Toxicity |url=https://www.ncbi.nlm.nih.gov/books/NBK459165/ |website=StatPearls |publisher=StatPearls Publishing |access-date=20 February 2023 |date=2022|pmid=29083729 }}</ref> Electrical cardioversion (to "shock" the heart) is generally not indicated in ventricular fibrillation in digitalis toxicity, as it can make the rhythm disturbance more complicated or sustained.<ref>{{Cite book|title=Mammalian Toxicology|last=Abou-Donia|first=Mohamed|publisher=John Wiley & Sons|year=2015|isbn=9781118683316|pages=631}}</ref><ref>{{cite journal |last1=Fuster |first1=Valentin |last2=Rydén |first2=Lars E. |last3=Cannom |first3=David S. |last4=Crijns |first4=Harry J. |last5=Curtis |first5=Anne B. |last6=Ellenbogen |first6=Kenneth A. |last7=Halperin |first7=Jonathan L. |last8=Le Heuzey |first8=Jean-Yves |last9=Kay |first9=G. Neal |last10=Lowe |first10=James E. |last11=Olsson |first11=S. Bertil |last12=Prystowsky |first12=Eric N. |last13=Tamargo |first13=Juan Luis |last14=Wann |first14=Samuel |title=ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—Executive Summary |journal=Journal of the American College of Cardiology |date=August 2006 |volume=48 |issue=4 |page=861 |doi=10.1016/j.jacc.2006.07.009|pmid=16904574 |s2cid=8975477 |doi-access=free }}</ref> Furthermore, the classic drug of choice for ventricular fibrillation in emergency setting,<ref>{{cite web |url=http://www.erc.edu |title=European Resuscitation Council}}{{Verify source|date=December 2008}}</ref> [[amiodarone]], can worsen the dysrhythmia caused by digitalis, therefore, the second-choice drug [[lidocaine]] is more commonly used.<ref>{{Cite book|title=Back to Basics: Critical Care Transport Certification Review|last=Lee Lopez|first=Orchid|publisher=Xlibris Corporation|year=2011|isbn=9781456862749|pages=290}}</ref> Mild toxicity is treated by stopping the medication and general supportive measures; severe toxicity is treated with [[Digoxin immune fab|anti-digoxin antibody fragments]].

The entire plant is toxic (including the roots and seeds). Mortality is rare, but case reports do exist. Most plant exposures occur in children younger than six years and are usually unintentional and without associated significant toxicity. More serious toxicity occurs with intentional ingestion by adolescents and adults.<ref>{{cite web |url=http://emedicine.medscape.com/article/816781-overview#a0199 |title=Cardiac Glycoside Plant Poisoning: Medscape reference|access-date=3 July 2012}}</ref>

In some instances, people have confused foxglove with the relatively harmless comfrey (''[[Symphytum]]'') plant, which is sometimes brewed into a tea, with fatal consequences. Other fatal accidents involve children drinking the water in a vase containing digitalis plants.<ref>{{cite web|url=http://www.cbif.gc.ca/pls/pp/ppack.info?p_psn=57&p_type=all&p_sci=sci |title=Notes on poisoning:''Digitalis purpura'' |last=Anon |work=Canadian poisonous plants information system |publisher=Canadian Biodiversity Information Facility |access-date=9 March 2013 |url-status=dead |archive-url=https://web.archive.org/web/20111013203513/http://www.cbif.gc.ca/pls/pp/ppack.info?p_psn=57&p_type=all&p_sci=sci |archive-date=13 October 2011}}</ref> Drying does not reduce the toxicity of the plant. The plant is toxic to animals, including all classes of livestock and poultry, as well as felines and canines.