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| Case, age, gender | Medical history | Procedure | Type of block | Amount of digoxin administered intrathecally | Physical exam findings | Diagnostic findings | Treatment | Number of days to recovery |
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| Case 1: 21 y.o. male [1] | ASA physical status 1 [1] | Thrombotic hemorrhoidectomy [1] | Spinal anesthesia [1] | 0.5 mg [1] | Paresthesias and paralysis for lower extremities to level of umbilicus, absent lower limb reflexes [1] | Normal: chest X-ray, electroencephalogram, electrocardiogram, head CT [1] | Not reported [1] | Full recovery at post-op 1 day (24 hours). Discharged on post-op day 2, no long-term sequelae at 5 month follow-up [1] |
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| Case 2: not reported [1] | Not reported [1] | Not reported, but noted to be similar to case 1 [1] | Not reported, but noted to be similar to case 1 [1] | 0.5 mg [1] | Not reported, but noted to be similar to case 1 [1] | Not reported, but noted to be similar to case 1 [1] | Not reported [1] | Not reported, but noted to be similar to case 1 [1] |
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| Case 3: not reported [1] | Not reported [1] | Not reported, but noted to be similar to case 1 [1] | Not reported, but noted to be similar to case 1 [1] | 0.5 mg [1] | Not reported, but noted to be similar to case 1 [1] | Not reported, but noted to be similar to case 1 [1] | Not reported [1] | Not reported, but noted to be similar to case 1 [1] |
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| Case 4: 52 y.o. male [2] | Complicated medical history significant for end-stage renal disease on hemodialysis three times a week [2] | Elective total hip hemiarthroplasty [2] | Spinal anesthesia [2] | 0.4 mg [2] | Symmetric, bilateral lower extremity weakness with subsequent paraplegia and upper extremity heaviness, with consequent sensory deficits to the C4-C5 levels, agitation and confusion 6 hours after steroid drip, dyspnea, right-sided gaze, lack of orientation to time, person, or place [2] | Cervical, thoracic, and lumbar MRI as well as brain CT were negative for spinal hematoma or cord compression, potassium elevated at 6.4 mEq/L (5.6 mEq/L prior to surgery and 5.2 mEq/L at baseline), digoxin level 1.9 ng/mL, ECG showed no acute changes, ABG: 7.35/42/83/23.2 on 2 L nasal cannula, SpO2 100%, repeat brain CT showed no acute changes, EEG showed no seizure activity [2] | Methylprednisolone 2500 mg IV, methylprednisolone drip at 5.4 mg/hr for 24 hours, calcium gluconate and regular insulin with 1 amp of D50W for hyperkalemia, with urgent hemodialysis, 2 L O2 nasal cannula for dyspnea [2] | Post-op day 2, the patient was alert and oriented to person and place, on evening of post-op day 3, the patient was able to move all extremities and follow simple commands |
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| Case 5: female, age not reported [3] | Peripartum, no other medical history reported [3] | Cesarean section [3] | Spinal anesthesia [3] | Not reported [3] | Decreased mental status followed by seizure, paraplegia of the limb [3] | Brain CT negative for acute pathology, MRI brain with significant bilateral frontal and temporal restriction with cortical ribboning, spinal MRI showed central cord edema with T2 signal changes, LP revealed high-opening pressure with elevated white blood cell counts and protein and low glucose, repeat MRI of the brain was normal and spine MRI with resolution of edema of the cervical spinal cord but persistent thoracic patchy signal intensity [3] | Intubation and ventilation, DIGIfab IV noted in report [3], additional treatment recommendations given by author via ResearchGate direct message: electroencephalography, trail antiepileptic drugs, external ventricular drain for shunting of cerebrovascular fluid, sustained low-efficiency dialysis to clear residual medication, CTA and MRA with DSA to evaluate for vasospasms with permissive HTN if pt is having vasospasms, intra-arterial verapamil for vasospasm, and IV milrinone | Approximately 1 week for recovery to baseline per direct discussion with the author of the report |
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| Case 6: female, age not reported [3] | Peripartum, no other medical history reported [3] | Cesarean section [3] | Spinal anesthesia [3] | Not reported [3] | Decreased mental status followed by seizure, paraplegia of limbs [3] | Brain CT negative for acute pathology, MRI brain with significant bilateral frontal and temporal restriction with cortical ribboning, spinal MRI showed central cord edema with T2 signal changes, LP revealed high-opening pressure with elevated white blood cell counts and protein and low glucose, repeat MRI of the brain was normal and spine MRI with resolution of edema of the cervical spinal cord but persistent thoracic patchy signal intensity [3] | Intubation and ventilation, DIGIfab IV noted in report [3], additional treatment recommendations given by author via ResearchGate direct message: electroencephalography, trail antiepileptic drugs, external ventricular drain for shunting of cerebrovascular fluid, sustained low-efficiency dialysis to clear residual medication, CTA and MRA with DSA to evaluate for vasospasms with permissive HTN if pt is having vasospasms, intra-arterial verapamil for vasospasm, and IV milrinone | Approximately 1 week for recovery to baseline per direct discussion with the author of the report |
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| Case 7 (our patient): 34 y.o. female | Peripartum, anxiety, hypothyroidism | Cesarean section | Spinal anesthesia | Not recorded in the patient’s record. Given the volume of the draw, suspect 0.5 mg | Post-op day 1: lightheadedness, fatigue, blurred vision, hypoxemia, quadriplegia, altered mental status, decreased responsiveness, unresponsive to noxious stimuli, dilated fixed pupils, absent gag, cough, and corneal reflexes, apnea. On day 2 of hospital admission, the patient remained unresponsive, with eight spontaneous shallow breaths per minute, absent brainstem reflexes, and no response to noxious stimuli | Chest and head CT negative for acute findings, digoxin levels on serial testing: 0.7 ng/ml and 0.6 ng/ml measured 6 hours apart. On day 3, brain MRI revealed severe cerebral edema with mild tonsillar herniation. Cervical spine MRI revealed diffuse edema. A nuclear medicine cerebral blood flow study revealed no intracranial activity, consistent with brain death | Intubation and ventilation, sugammadex IV initially given prior to revelation of medication error, low-dose propofol infusion, IV methylprednisolone (1 gram daily for 3 days), empiric IV infusion of 18 vials of digoxin-specific antibody (DIGIFab) (40 mg per vial), | Withdrawal of life support and time of death reported on day 3 of hospitalization |
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