Digitalis intoxication is poisoning with cardiac glycosides. It is worth saying that this is a rather serious complication in the treatment of patients who suffer from cardiac pathologies and take drugs of the digitalis category (for example, Digoxin). Lethal dosages of cardiac glycosides, as a rule, can be ten times or more higher than therapeutic ones. Particularly sensitive to them are the elderly and patients with impaired thyroid function, blood circulation and excretion systems. The toxicity of digitalis class drugs increases in the presence of hypomagnesemia and hypokalemia. Children are more resistant to them.
Reasons
Digoxin, widely used as a drug that reduces the frequency of ventricular contractions against the background of atrial fibrillation, belongs to cardiac glycosides. The use of this drug for these purposes is often ineffective if the patient leads an active lifestyle. Plaindosage is 0.25 milligrams per day. A number of factors lead to the occurrence of digitalis intoxication and is the basis for dose reduction. Causes include: hypokalemia along with impaired kidney function, age, dehydration (often due to diuretic treatment), medications such as Verapamil or Amiodarone.
Clinical symptoms
The clinical picture of digitalis intoxication consists of several leading signs, in particular:
- GI symptoms.
- Cardiac and vascular manifestations.
- Psycho-neurological vision disorder.
First of all, patients experience dyspeptic manifestations in the form of nausea, continuous vomiting with an admixture of bile in the excreted mass, sometimes blood, abdominal pain and signs of dehydration. Possible manifestations of digitalis intoxication should not go unnoticed. Soon there is a headache along with dizziness and visual impairment in the form of xanthopsia, annular cattle, decreased visual acuity. As a result, retrobulbar neuritis occurs. Ataxia is characteristic, among other things, along with insomnia, agitation, delirium, hallucinations, convulsions, shortness of breath, cyanosis, hypoxia, and decreased urine output.
Digitalis effect on ECG - what is it?
On an ECG study, along with a decrease in the ST interval and a flattened T wave, the PQ indicator can be lengthened, among other things, atrial single P waves fall out. Rhythm and conduction disorders are often noted,especially when acute poisoning with glycosides is preceded by a violation of cardiac activity in the form of bradycardia, blockade, and so on. Extremely dangerous with digitalis intoxication on the ECG is the development of ventricular extrasystole, paroxysmal type of tachycardia and atrial fibrillation. In such cases, death may occur due to asphyxia or cardiac arrest.
Emergency
The program of assistance with the development of acute intoxication with glycosides provides for early detoxification through resuscitation measures and antidotes, in addition to interrupting the enterohepatic circulation (especially if the poisoning is associated with "Digitoxin" or "Isolanide"). It is very important to eliminate the manifestation of PSCE, arrhythmia, vomiting, agitation and hypoxia. Improvement of contractile functions of the myocardium is required. To do this, do the following:
- Cessation of cardiac glycoside treatment.
- The introduction of "Unithiol", vitamin "E" and glycocorticoids to reduce the manifestation of PSCE on the first day three times, and on the following days twice.
- Repeated gastric lavage, introduction of saline laxative and activated charcoal through the tube to prevent the absorption of poison in the digestive system. It is also necessary to ingest 200 milliliters of vaseline oil or 8 grams of cholestyramine, which ensures the cessation of circulation in the event that intoxication was caused by Isolanid or Digitoxin.
- Providing oxygen inhalation with digitalis effect, performing10% glucose infusion with insulin, vitamin B6.
- Normalization of the rhythm and conduction of the heart with antiarrhythmic drugs, with the exception of Quinidine and Novocainamide, which are contraindicated. If there is no effect, defibrillation or cardiac pacing is performed.
- Against the background of the presence of hypokalemia, potassium preparations are used in the form of Panangin or sodium aspartate.
Antidote for cardiac glycoside poisoning
Specific antidote in the presence of digitalis intoxication with glycosides, especially digoxin preparations, are fragments of specific antibodies. The essence of their antidote activity is in the process of binding free digoxin contained in the blood plasma after a relative or absolute overdose, and thus preventing its cooperation with myocardial cells. The drug is used in a dose of 800 milligrams, that is, twenty ampoules of 40 milligrams.
Digoxin antibody fragments are derived from specific elements produced in the body of sheep. Their relationship with lantoside and digitoxin is greater than the relationship of these glycosides with receptors in the myocardium. Therefore, these substances preferentially bind to fragments of specific antibodies, and not to receptors in the myocardium and other tissues.
Half an hour after the introduction of the antidote in the blood, the content of digoxin or another glycoside that contributes to intoxication begins to grow. Glycosides combined with protein lose pharmacologicalactivity, and they are so excreted from the body. The dosage of the medicine is set individually, and it directly depends on the amount of poison that has been absorbed. The calculation of the dosage is carried out according to the instructions that are attached to the pharmaceutical product.
What is the treatment for digitalis poisoning?
Carrying out therapy with the development of such a pathology
A highly undesirable complication with the use of digitalis antidote is an allergic reaction among sensitized patients who have been previously administered preparations containing sheep protein.
The vagomimetic effect of glycosides (that is, bradycardia and vomiting) must be eliminated with atropine sulfate (1 milliliter of solution). In case of arrhythmias that have arisen due to digitalis intoxication, Difenin or a polarizing mixture is used (100 milliliters of ten percent glucose plus 0.5 grams of potassium chloride and 2 units of insulin, and 100 milligrams of cocarboxylase is added). In order to improve the activity of the heart, "Riboxin" is used.
Dehydration of the body is eliminated by the introduction of an infusion solution of five percent glucose with insulin. As for seizures, they are eliminated with drugs in the form of sodium hydroxybutyrate, Sibazon and Aminazin. Shown oxygen therapy and vitamin therapy. In the absence of positive results, it is advisable to carry out hemosorption, and in case of severe poisoning with "Digoxin" or "Strophanthin", hemodialysis is required along with the introductionspecific antibodies.
What is digitalis preparations?
The cardiac glycosides that cause this kind of intoxication include drugs that are obtained from purple foxglove. These are Digitoxin, Cordigite, Digoxin, Acetyldigitoxin, Acetyldigoxin, Gitoxin, Celanide and Lantoside.
What can complicate this kind of intoxication?
A number of factors influence the speed of poisoning processes:
- The advanced age of the patient, which slows down the rate of excretion of toxic components from the body and contributes to their accumulation in the blood.
- The presence of kidney disease, the drug is excreted in the urine, and the poor functioning of this organ provokes an increase in the level of digitalis ingredients in the blood.
- Failures in the liver, which binds the components of digitalis with other components.
- A hormonal disorder that affects the speed of the metabolic process.
- Severe heart disease, pre-infarction conditions.
- Some lung diseases that make breathing difficult.
- Long course of diuretics.
Conclusion and main conclusions on the article
Thus, the appointment of cardiac glycosides is solely the prerogative of the doctor. Self-treatment in this case can be extremely dangerous to he alth and life. With long courses of therapy or the presence of aggravating reasons, blood control is recommended every six hours after using the drug, allsigns of poisoning are well displayed on the ECG.
