Yale University School of Medicine heart book. Thacker D, Sharma J. Slideshow Medically Significant Spider Bites: Such preventive measures should include appropriate digoxin serum concentration measurement, evaluation of pharmacotherapy regimens for potential drug interactions, assessment of electrolytes, and digoxin regimen determination based on pharmacokinetic parameters.
Magnesium sulfate may terminate dysrhythmias, but is contraindicated in the setting of bradycardia or AV block and should be used cautiously in patients with renal failure.
Morbidity and mortality rates increase if the patient has a new dysrhythmia, advanced AV block, or other significant ECG abnormality. Therefore, the dose of digoxin immune Fab is based on the amount of excess digoxin believed to be present in the patient experiencing toxicity. The slowing of rate and rhythm are attributed to digoxin's impact on the central nervous system, leading to increased vagal activity that results in slowed conduction in the atrioventricular AV node.
Hyperkalemia may result from acute poisoning of the sodium-potassium ATPase. Lack of age-related differences in the clinical presentation of digoxin toxicity. William Morrow and Co; Koren G, Parker R. Enhancement of automaticity, which results from an increase in the rate of phase 4 depolarization and from delayed after-depolarization. In fact, for more than years, digoxin was the main agent used for this indication.
Clearance of digoxin is also decreased in patients with hypothyroidism and in drug interactions with amiodarone, quinidine, and verapamil. Home Subscribe Continuing Education Archives. Activated charcoal safe and effective for digoxin toxicity [letter].
Thus, the therapeutic range of digoxin concentration currently recommended for the treatment of heart failure is 0. Additionally, the antibodies used in a digoxin immunoassay can cross-react with numerous compounds, including steroids and spironolactone.
Digoxin reduces cardiac sympathetic activity in severe congestive heart failure. Practice Essentials The incidence of digitalis toxicity has declined in recent years, due to decreased use along with improved technology for monitoring of drug levels and increased awareness of drug interactions. More trials are needed to further test this theory. Collateral effects of antiarrhythmics in pediatric age. Alterations in cardiac rate and rhythm from digitalis toxicity may simulate almost every known type of dysrhythmia.
The evolving pattern of digoxin intoxication: