Digital intoxication is cardiac glycoside poisoning. It is worth saying that this is a rather serious complication of the treatment of patients who suffer from cardiac pathologies and take drugs of the digitalis category (for example, Digoxin). Lethal doses of cardiac glycosides, as a rule, are ten times or more higher than therapeutic. Particularly sensitive to them are the elderly and patients with impaired thyroid function, blood circulation and excretion. The toxicity of digitalis class drugs increases in the presence of hypomagnesemia and hypokalemia. Children are more resistant to them.
Causes
Cardiac glycosides include Digoxin, which is widely used as a drug that reduces the frequency of contractions of the ventricles due to atrial fibrillation. The use of this medicine for these purposes is often ineffective if the patient leads an active lifestyle. The usual dosage is 0.25 milligrams per knock. A number of factors lead to digital intoxication and are the basis for dose reduction. The reasons include: hypokalemia along with impaired renal function, age, dehydration (often due to treatment with diuretics), taking Verapamil or Amiodaron medications.
Clinical symptoms
The clinical picture of digital intoxication consists of several leading signs, in particular:
- Gastrointestinal symptoms.
- Cardiac and vascular manifestations.
- Neuropsychiatric visual impairment.
First of all, patients have 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 digital intoxication should not go unnoticed. Soon a headache appears along with dizziness and visual impairment in the form of xanthopsia, ring-shaped cattle, and 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 a decrease in urine output.
Digital effect on ECG - what is it?
In 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, the atrial single teeth of the R. fall out, rhythm and conduction disorders are often noted, especially when acute glycoside poisoning is preceded by a violation of cardiac activity in the form of bradycardia, blockade, and so on. The development of ventricular extrasystole, a paroxysmal type of tachycardia and atrial fibrillation is considered extremely dangerous for digitalis intoxication on an ECG. In such cases, death may occur due to asphyxiation or cardiac arrest.
Urgent Care
The assistance program for the development of acute glycoside intoxication provides for early detoxification through resuscitation and antidotes, in addition to interrupting 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 myocardial contractile function is required. To do this, do the following:
- Discontinuation of treatment with cardiac glycosides.
- The introduction of "Unithiol", vitamin "E" and glycocorticoids to reduce the manifestation of PSCE on the first day three times, and on subsequent days twice.
- Repeated gastric lavage, injection through a probe of saline laxative and activated carbon to prevent the absorption of poison in the digestive system. It is also necessary to take 200 milliliters of liquid paraffin or 8 grams of cholestyramine inside, which ensures the cessation of circulation if intoxication was caused by Isolanide or Digitoxin.
- Ensuring oxygen inhalation with the digitalis effect, infusion with ten percent glucose with insulin, vitamin B6.
- Normalization of the rhythm and conduction of the heart with antiarrhythmic drugs, with the exception of Quinidine and Novokainamide, which are contraindicated. In the absence of 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 asparaginate.
Antidote in case of cardiac glycoside poisoning
In the presence of digitalis intoxication with glycosides, in particular digoxin preparations, fragments of specific antibodies are a specific antidote. The essence of their antidote activity is the binding of 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.
Fragments of antibodies against digoxin are obtained 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 predominantly bind to fragments of specific antibodies, and not to receptors in the myocardium and other tissues.
Half an hour after entering the antidote in the blood, the content of digoxin or other glycoside, which contributes to intoxication, begins to increase. The glycosides bound to the protein lose their pharmacological activity and are thus excreted from the body. The dosage of the drug is set individually, and this directly depends on the amount of poison that has been absorbed. Dosage calculation is carried out according to the instructions that are attached to the pharmaceutical preparation.
What is the treatment for digital intoxication?
Conducting therapy with the development of such a pathology
An extremely undesirable complication when using a digital antidote is an allergic reaction among sensitized patients who have previously been administered preparations containing sheep's protein.
The vagomimetic effect of glycosides (i.e. bradycardia and vomiting) must be eliminated with atropine sulfate (1 milliliter of solution). In case of arrhythmias that have arisen due to digitalis intoxication, Diphenin 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 using "Riboxinum".
Dehydration is eliminated by administering a 5% glucose infusion solution with insulin. As for seizures, they are eliminated with drugs in the form of sodium oxybutyrate, Sibazon and Aminazin. Oxygen therapy and vitamin therapy are indicated. In the absence of positive results, hemosorption is advisable, and in case of severe poisoning with Digoxin or Strofantin, hemodialysis is required along with the introduction of specific antibodies.
What is related to digital drugs?
Cardiac glycosides that cause this kind of intoxication include drugs that are obtained from digitalis purpurea. We are talking about “Digitoxin”, “Cordigit”, “Digoxin”, “Acetyldigitoxin”, “Acetyldigitoxin”, “Gitoxin”, “Celanide” and “Lantozide”.
What can complicate intoxication of this kind?
A number of factors influence the speed of poisoning processes:
- The elderly patient, which slows down the rate of elimination of toxic components from the body and contributes to their accumulation in the blood.
- The presence of kidney disease, the drug leaves 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 are associated with digitalis components with other components.
- Hormonal disorder affecting the speed of the metabolic process.
- Severe heart disease, pre-infarction conditions.
- Some lung diseases that make breathing difficult.
- A long course of taking diuretics.
Conclusion and main conclusions on the article
Thus, the appointment of cardiac glycosides is exclusively the prerogative of the doctor. To engage in self-treatment in this case can be extremely dangerous for health and life. With prolonged courses of therapy or the presence of aggravating reasons, blood control is recommended every six hours after using the drug, all signs of the onset of poisoning are well displayed on the ECG.