![]() Serum concentration (nmol/L) x 0.781 x patient weight (kg)ĭigoxin levels done greater than 6 hours post dose more accurately reflect toxicity. *Note: Round up to the next highest number of vials. Repeat if needed for ongoing toxicity.Īmount Ingested Known: Dose (in vials)* = With hemodynamic compromise: Give 2-4 vials over 30 minutes by IV infusion.If full amount not available, give closest amount available. Cardiac arrest imminent or present: 10 vials by direct IV, repeat 5 - 10 vials as needed for ongoing toxicity, after 3 - 5 min.Acute or chronic life-threatening digoxin toxicity (or other cardioactive steroid: digitoxin, plants, toad venom): tachy or brady-arrhythmias, hypotension, hyperkalemia (greater than 5 mEq/L) and/or a digoxin serum level of greater than 12.8 nmol/L (greater than 10 ng/mL).Įmpiric Dosing (Unknown level and severe toxicity):.However since you are probably more likely to encounter patients with chronic toxicity, this new strategy may serve as a more cost and resource efficient way to treat these patients.ALERT: This item is found in the refrigerator antidote kit. Clearly for the patient that takes a massive overdose, providers may still need to initially be very aggressive in administering the antidote. If this develops, all you have to do administer more. When using a low-dose strategy, some patients may develop a recrudescence of their symptoms as the fab fragments are small and cleared rapidly. The literature seems to indicate that most patients can be effectively treated with 1-2 vials and then redosed as needed. The good news is new research indicates that we can effectively treat patients with much lower doses. Given that the antidote is expensive and digoxin overdoses are uncommon, many hospitals might not stock enough to treat a single patient or run out if they had to treat multiple patients. Even using a conservative approach (serum concentration X patient weight / 100) could lead to the administration of 4-6 vials. Some recommendations were to use 10-20 vials empirically. Second, recommendations were to use very large amounts of the antidote. First off, the medication can be quite expensive. While both Digibind® and Digifab® are very safe, the standard dosing recommendations led to some big problems. As such this lead to very liberal use of these fab fragments. For instance, patients with a potassium > 5 mEq/L had a mortality of 50% before the development of digoxin immune fab (better known as Digibind® or Digifab®). The hyperkalemia is not generally a huge problem or the cause of arrhythmia in many of these patients however, it serves as a surrogate marker for toxicity and indicates severe cardiac poisoning which is the real problem. In addition to arrhythmias, patients with acute ingestions could develop hyperkalemia. Most concerning is that patients can develop a wide spectrum of arrhythmias leading to cardiovascular collapse and death. Signs and symptoms of digoxin toxicity are non-specific and include nausea and vomiting. The end result is a supratherapeutic concentration of digoxin, which is referred to as a chronic overdose. For example, the patient develops renal failure but their dose is not adjusted. It generally refers to a problem with excretion. Acute is when a patient takes too many such as in a suicide attempt while chronic is really a misnomer. Overdoses are divided into acute and chronic overdoses. It can also cause substantial morbidity and mortality if patients overdose or develop supratherapeutic concentrations. It also can increase parasympathetic tone and decrease conduction at the AV node, which is a good thing if you have an atrial tachyarrhythmia such as atrial fibrillation. The end result is that more calcium stays in the myocytes and contractility is improved. Unfortunately, not realizing a patient is taking digoxin could have dire consequences.įor those that are unfamiliar with digoxin, it blocks cardiac sodium potassium ATPase. What once was commonly found on an elderly patient’s medication list could now easily go unnoticed if an accurate history is not obtained. As time has gone by, newer medications became available and displaced digoxin as the medication of choice for these diseases. Digoxin and cardiac glycosides have long been used to treat disorders such as congestive heart failure and atrial fibrillation.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |