OVERVIEW
Overview of Digoxin Poisoning
Digoxin toxicity is a series of clinical reactions resulting from elevated blood concentrations of digoxin above a certain range. Concomitant administration of other drugs during digoxin therapy may alter the blood concentration of digoxin by affecting absorption or excretion and may lead to toxicity. Hypokalemia, hypothyroidism, hypertension, alkalosis, ischemic cardiomyopathy, incomplete atrioventricular block, acute myocardial infarction, renal insufficiency, etc. are all susceptible to poisoning.
Whether medical insurance
Yes
Consultation department
Emergency Medicine, Cardiovascular Medicine
Clinical symptoms
Malignancy, vomiting, diarrhea, abdominal pain, sudden and significant slowing or acceleration of the heart rate, premature beats, dizziness, headache, insomnia, tinnitus, confusion, yellow vision, green vision, diplopia, and decreased urine output.
Harms
Symptoms of damage to multiple organs and systems, such as cardiovascular system, nervous system, digestive system, etc., can occur, and in serious cases, life is jeopardized.
Complications
Renal failure, etc.
Examination
Blood routine, blood digoxin concentration measurement, electrolyte measurement, liver function test, renal function test, immunology test, echocardiography, electrocardiography, etc.
Diagnosis
Diagnosis is made on the basis of medical history, malignancy, vomiting, dizziness, tinnitus, confusion, blurred vision, decreased urine output, and significant improvement or disappearance of symptoms with discontinuation of digoxin, combined with measurement of blood digoxin concentration and electrocardiography.
Treatment principle
Immediate discontinuation of digoxin, anti-digoxin therapy, symptomatic treatment.
Curability
In mild cases, discontinuation of digoxin can lead to improvement; in severe cases, active treatment can relieve symptoms.
Dietary recommendations
Low-salt, low-fat, easy-to-digest diet, small and frequent meals.
Etiology
Etiology
Overdose of digoxin, or taking other drugs at the same time affects the absorption or excretion of digoxin leading to poisoning.
Symptoms and Diagnosis
Typical symptoms
1. Gastrointestinal symptoms
Malaise, vomiting, diarrhea, anorexia, etc. Anorexia is the earliest manifestation.
2. Cardiac manifestations
Various types of cardiac arrhythmias, such as ventricular pre-systole, multiple premature ventricular beats, sinus arrest, atrioventricular block, ventricular tachycardia, ventricular fibrillation, etc., are common.
3. Nervous and mental symptoms
Dizziness, lightheadedness, insomnia, tinnitus, drowsiness, ataxia, cramps, confusion, hallucinations, rigidity, delirium, etc.
4. Visual abnormalities
Blurred vision, yellow or green vision, diplopia and phantom vision, etc.
Other symptoms
Decreased urine output.
Diagnostic basis
1. History of taking digoxin for heart failure, atrial fibrillation and other diseases.
2. Digoxin poisoning should be considered when any of the following manifestations occur during the application of digoxin.
(1) Heart failure once improved and then aggravated with clinical manifestations of digoxin poisoning.
(2) The emergence of new arrhythmias or changes in existing arrhythmias during the use of digoxin.
(3) Significant improvement or complete disappearance of arrhythmia within 1-3 days after stopping digoxin.
(3) Elevated drug concentration as measured by blood digoxin concentration.
Treatment
Treatment guidelines
Immediate discontinuation of digoxin, anti-digoxin treatment, potassium supplementation for low potassium, symptomatic treatment.
Drug therapy
1. Potassium supplementation
Hypokalemia with good renal function, appropriate potassium supplementation is often effective in eliminating arrhythmias.
2. Phenytoin sodium
Intravenous slow drip or oral.
3. Antiarrhythmic drugs
Lidocaine, effective in eliminating ventricular arrhythmias. Atropine and ipratropium bromide, available for bradyarrhythmias. Calcium sodium edetate, has the effect of chelating with calcium, can be used to treat the arrhythmia caused by digitalis.
4. Anti-digoxin effect
Give digoxin immune Fab fragment, can release digoxin and sodium pump binding, and make it inactivate, liver insufficiency when the dose is reduced.
5.Ion exchange resin
Intestinal luminal polyvalent complexed cardiac glycosides.
Other treatments
1. ventricular fibrillation should be cardiopulmonary resuscitation or electric defibrillation.
2. Those with severe bradycardia should be given cardiopulmonary resuscitation, application of atropine or pacemaker.
3. Blood purification therapy, plasma exchange is feasible in acute and severe cases.
Prognosis
Mild cases can be improved by stopping digoxin, and severe cases can improve the prognosis by active treatment.
Nursing care
Daily care
1. Pay attention to rest.
2. Prevent respiratory tract infection.
3. Do what you can under the guidance of the doctor, step by step, don’t be too hasty.
Diet
Low-salt, low-fat, easy-to-digest diet, appropriate restriction of calorie and protein intake, small and frequent meals.