Heart 89:e14 doi:10.1136/heart.89.4.e14
  • Electronic pages

Toad venom poisoning: resemblance to digoxin toxicity and therapeutic implications

  1. R M Gowda1,
  2. R A Cohen1,
  3. I A Khan2
  1. 1Division of Cardiology, Woodhull Medical Center, Brooklyn, New York, USA
  2. 2Division of Cardiology, Creighton University Medical Center, Omaha, Nebraska, USA
  1. Correspondence to:
    Dr I A Khan, Creighton University Cardiac Center, 3006 Webster Street, Omaha, NE 68131, USA:
  • Accepted 19 December 2002


A healthy man developed gastrointestinal symptoms after ingesting purported aphrodisiac pills. He had severe unrelenting bradycardia, hyperkalaemia, and acidosis. He rapidly developed severe life threatening cardiac arrhythmias and died after a few hours. He was found to have positive serum digoxin concentrations, although he was not taking digoxin. Toad venom poisoning is similar to digitalis toxicity and carries a high mortality. Cardiac glycoside poisoning can occur from ingestion of various plants and animal toxins, and the venom gland of cane toad (Bufo marinus) contains large quantities of cardiac glycosides. Toad venom, a constituent of an aphrodisiac, was considered responsible for the development of clinical manifestations and death in this patient. Digoxin specific Fab fragment has been reported to be beneficial in the treatment of toad venom poisoning. This report alerts physicians to the need to be aware of a new community toxic exposure, as prompt treatment with digoxin specific Fab fragment may be life saving. The treatment approach to patients with suspected toad venom poisoning is described.


  • No financial support was received for this paper.