RECOGNITION AND MANAGEMENT OF DIGITALIS TOXICITY

被引:81
作者
KELLY, RA
SMITH, TW
机构
[1] BRIGHAM & WOMENS HOSP,DEPT MED,DIV CARDIOVASC,75 FRANCIS ST,BOSTON,MA 02115
[2] HARVARD UNIV,SCH MED,DEPT MED,BOSTON,MA 02115
关键词
D O I
10.1016/0002-9149(92)91259-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The most important step in the management of toxicity due to any of the cardiac glycosides is its recognition. Despite the development of an accurate clinical assay for serum levels of digoxin > 20 years ago, digitalis toxicity remains common and difficult to confirm, even ff suspected, due primarily to 2 factors. First, the signs and symptoms of digitalis toxicity, most commonly an abnormal electrocardiogram showing ventricular or atrial arrhythmias, with or without some degree of concurrent atrioventricular block, often also occur in patients with congestive heart failure (CHF) and underlying coronary atherosclerosis who are not receiving a cardiac glycoside. Second, due to digoxin's narrow therapeutic ratio, the marked degree of variability in the sensitivity of individual patients to its toxic effects, and the common problem of obtaining blood samples inappropriately during the early distribution phase following dosing, a serum digoxin concentration often does not serve as a reliable indicator of toxicity. Despite these difficulties in diagnosis, the management of digoxin toxicity has been made much more effective with the widespread availability of F(ab) fragments of antidigoxin antibodies. This drug provides the clinician with a rapidly acting, safe antidote for all commonly used digitalis preparations. Conventional therapy for digoxin toxicity remains the maintenance of serum potassium levels greater-than-or-equal-to 4 mEq/liter, reversal of decompensated CHF or overt myocardial ischemia, attention to serum magnesium levels and the patient's acid-base status, appropriate antiarrhythmics in the event of ventricular arrhythmias, and a temporary pacemaker for high-grade atrioventricular block. Nevertheless, the high specificity and documented safety of the antibody preparation provides a needed safety net for the continuing use of cardiac glycosides as first-line inotropic agents in the modern therapy of chronic CHF.
引用
收藏
页码:G108 / G119
页数:12
相关论文
共 44 条
[1]   TREATMENT OF 150 CASES OF LIFE-THREATENING DIGITALIS INTOXICATION WITH DIGOXIN-SPECIFIC FAB ANTIBODY FRAGMENTS - FINAL REPORT OF A MULTICENTER STUDY [J].
ANTMAN, EM ;
WENGER, TL ;
BUTLER, VP ;
HABER, E ;
SMITH, TW .
CIRCULATION, 1990, 81 (06) :1744-1752
[2]   RECOGNITION AND MANAGEMENT OF DIGITALIS INTOXICATION - IMPLICATIONS FOR EMERGENCY-MEDICINE [J].
BAYER, MJ .
AMERICAN JOURNAL OF EMERGENCY MEDICINE, 1991, 9 (02) :29-32
[3]   DIGITALIS INTOXICATION - PROSPECTIVE CLINICAL STUDY WITH SERUM LEVEL CORRELATIONS [J].
BELLER, GA ;
SMITH, TW ;
ABLEMANN, WH ;
HABER, E ;
HOOD, WB .
NEW ENGLAND JOURNAL OF MEDICINE, 1971, 284 (18) :989-+
[4]   EFFECT OF DIGITALIS TREATMENT ON SURVIVAL AFTER ACUTE MYOCARDIAL-INFARCTION [J].
BIGGER, JT ;
FLEISS, JL ;
ROLNITZKY, LM ;
MERAB, JP ;
FERRICK, KJ .
AMERICAN JOURNAL OF CARDIOLOGY, 1985, 55 (06) :623-630
[5]   IMMUNOLOGICAL TREATMENT OF DIGITALIS TOXICITY - A TALE OF 2 PROPHECIES [J].
BUTLER, VP ;
SMITH, TW .
ANNALS OF INTERNAL MEDICINE, 1986, 105 (04) :613-614
[6]   ASSOCIATION OF DIGITALIS THERAPY WITH MORTALITY IN SURVIVORS OF ACUTE MYOCARDIAL-INFARCTION - OBSERVATIONS IN THE BETA-BLOCKER HEART-ATTACK TRIAL [J].
BYINGTON, R ;
GOLDSTEIN, S .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1985, 6 (05) :976-982
[7]   LIFE-THREATENING HYPERKALEMIA IN SEVERE HEART-FAILURE [J].
CHAKKO, SC ;
FRUTCHEY, J ;
GHEORGHIADE, M .
AMERICAN HEART JOURNAL, 1989, 117 (05) :1083-1091
[8]   COMBINED PROPRANOLOL AND DIGOXIN THERAPY IN ANGINA-PECTORIS [J].
CRAWFORD, MH ;
LEWINTER, MM ;
OROURKE, RA ;
KARLINER, JS ;
ROSS, J .
ANNALS OF INTERNAL MEDICINE, 1975, 83 (04) :449-455
[9]  
DANON A, 1977, CLIN PHARMACOL THER, V21, P643
[10]   ELECTROPHYSIOLOGICAL EFFECTS OF OUABAIN ON SINUS NODE AND ATRIUM IN MAN [J].
DHINGRA, RC ;
AMATYLEON, F ;
WYNDHAM, C ;
WU, D ;
DENES, P ;
ROSEN, KM .
JOURNAL OF CLINICAL INVESTIGATION, 1975, 56 (03) :555-562