Digitalis intoxication treatment. Intoxication with cardiac glycosides Potassium preparation for intoxication with cardiac glycosides

Intoxication with cardiac glycosides is more often due to a decrease in tolerance than a true overdose.

Factors contributing to intoxication with cardiac glycosides:

The occurrence of glycoside intoxication can be facilitated by:

1) the proximity of the full therapeutic and toxic doses of glycosides;

2) decreased tolerance or complete intolerance to glycosides due to severe myocardial damage;

3) general potassium deficiency (treatment with potassium-releasing diuretics; metabolic alkalosis and increased kaliuresis against the background of the use of large doses of glucocorticosteroids);

4) myocardial hypocaligistia in myocardial infarction, myocarditis; myocardial hypoxia as a result of arterial hypoxemia in acute and chronic diseases lung, pleural effusions; pulmonary thromboembolism; chronic cor pulmonale;

5) electropulse therapy after previous digitalization (it is believed that this therapy leads to a loss of myocardial potassium);

6) transferred glycoside intoxication increases the sensitivity of the myocardium with subsequent appointments of glycosides, especially in the near future. This is explained along with myocardial hypocaligistia by the occurrence of so-called Buechner myocardial necrosis;

7) hypercalcemia;

8) hypomagnesemia;

9) renal failure (decrease in the elimination of cardiac glycosides);

10) liver failure (slowing down the processes of destruction of cardiac glycosides; reducing the deactivation of hormones that affect the water and electrolyte balance,– secondary hyperaldosteronism);

11) simultaneous use of certain drugs (calcium chloride, especially when administered intravenously, catecholamines, aerosol sympathomimetics in patients bronchial asthma and cor pulmonale, eufillin, in rare cases - preparations of rauwolfia);

12) elderly and old age.

Symptoms of intoxication with cardiac glycosides:

Among clinical manifestations glycosidic intoxication, first of all, cardiovascular disorders should be noted. An increase in circulatory failure is noted as a manifestation of the damaging effect of toxic doses of glycosides on the myocardium; cardiac arrhythmias and conduction disturbances are the most common and sometimes dangerous manifestations glycoside intoxication. With glycoside intoxication, there are:

a) violations of the formation of a sinus impulse ( sinus tachycardia and bradycardia, sinus node palsy, sinoatrial block);

b) atrial arrhythmias (atrial tachycardia with and without incomplete atrioventricular block, atrial extrasystoles, pacemaker migration through the atria, atrial fibrillation and flutter);

c) nodal tachycardia, nodal extrasystoles, nodal rhythms;

d) ventricular arrhythmias (ventricular extrasystoles, including bigeminia, frequent and polytopic extrasystoles; ventricular tachycardia; ventricular fibrillation);

e) various degrees of atrioventricular blockade; Frederick's phenomenon (complete atrioventricular block in combination with atrial fibrillation, preceding the development of digitalis intoxication). Thus, with glycoside intoxication, almost any kind of rhythm and conduction disturbances occur. The most frequent, however, are ventricular extrasystole, especially bigeminy with polymorphic ventricular complexes.

In doubtful cases with ectopic arrhythmias for differential diagnosis a test with intravenous drip of 2% sodium citrate solution can be used. At the same time, the content of ionized calcium in the blood (a synergist of glycosides) decreases and glycosidic arrhythmias are eliminated. The test is specific in the diagnosis of glycoside intoxication.

Gastrointestinal symptoms(loss of appetite, nausea, vomiting, rarely diarrhea) is associated mainly with direct or reflex excitation of the vomiting center by toxic doses of cardiac glycosides. There is a decrease in daily diuresis.

Cardiac glycosides can cause visual impairment (objects appear colored in yellow, less often there is a feeling of flashing "flies" before the eyes, scotomas are noted, the perception of objects in a reduced or enlarged form; decreased visual acuity). Neurological symptoms(insomnia, headache, dizziness, depression, confusion, aphasia, delirium, neuritis trigeminal nerve, sciatica, intercostal neuralgia, paresthesia upper limbs) sometimes serve as the only manifestation of intoxication. Cases of gynecomastia have been described.

Prevention of glycoside intoxication:

Among the measures to prevent glycoside intoxication is primarily the rational appointment of glycosides, taking into account contraindications, as well as factors that reduce tolerance to glycosides; rational dosing with careful monitoring of the effect of treatment.

It is also necessary to carry out measures aimed at increasing tolerance to cardiac glycosides:

a) treatment of the underlying disease and its complications (myocarditis, bacterial endocarditis, chronic pulmonary infection, thromboembolic complications) with the use of antibiotics, thrombolytic agents and anticoagulants, glucocorticosteroids, etc., respectively;

b) bloodletting in case of refractory right ventricular failure, symptomatic polycythemia;

c) pleural puncture, paracentesis in the presence of hydrothorax and ascites, which violate the ventilation of the lungs;

d) introduction respiratory analeptics(cordiamin, eufillin), carrying out auxiliary hardware breathing in case of severe respiratory failure and violation of the rhythm of breathing;

e) oxygenation; with refractory heart failure, hyperbaric oxygen therapy increases tolerance to cardiac glycosides;

f) the use of agents that improve myocardial metabolism (inosine, riboxin, anabolic agents - retabolil, nerobol, potassium orotate);

g) the appointment of spirolactones (veroshpiron) in combination with glucocorticosteroids and diuretics in severe heart failure and secondary hyperaldosteronism;

h) prophylactic administration of potassium salts, panangin, sometimes - polarizing mixtures;

i) timely cancellation of drugs that reduce tolerance to glycosides (calcium chloride, sympathomimetics such as isadrin, etc.);

j) to prevent post-defibrillation arrhythmias - timely withdrawal of digitalis preparations (isolanide, digoxin 3-5 days before; digitoxin, digitalis leaf powder, acedoxin - 7-10 days before electropulse therapy).

Treatment of glycoside intoxication:

Treatment of glycoside intoxication begins primarily with the abolition of cardiac glycosides when signs of intoxication appear. In mild cases, withdrawal of glycosides may be sufficient to eliminate the symptoms of intoxication. In addition, they carry out a set of measures listed in the section "Prevention of glycoside intoxication" (see above).

Drugs used in the treatment of glycoside intoxication should be divided into two groups.

I group of drugs used in the treatment of intoxication with cardiac glycosides:

The first group includes agents used in all cases of glycoside intoxication, including digitalis heart block:

1. Unitiol is injected 5 ml of a 5% solution intramuscularly 2-3 times a day for 3-6 days, then 5 ml intramuscularly 1 time a day for another 2-4 days. When resuming treatment with glycosides, to increase tolerance to them, unithiol is administered intramuscularly at a dose of 5 ml 30 minutes before the administration of strophanthin or corglicon.

2. Oxygenation, hyperbaric oxygen therapy.

3. The introduction of complexones to bind ionized calcium. With the introduction of 50–250 ml of a 2% solution of sodium citrate intravenously, the drip therapeutic effect occurs after a few minutes (mainly with ectopic arrhythmias), but lasts no more than 20 minutes. Side effects are unknown. With the appointment of 3-4 g of disodium salt of ethylenediaminetetraacetic acid (Na2 EDTA) in 250 ml of 5% glucose solution, a quick but short-term effect is noted. frequent side effects(feeling of heat, nausea, dizziness, pain along the vein).

4. Difenin inhibits ectopic activity while improving atrioventricular conduction. The drug is effective both in the treatment of ectopic arrhythmias and in disorders of atrioventricular conduction of glycosidic origin (excluding complete atrioventricular blockades). Difenin is administered intravenously at a dose of 125–250 mg over 1–3 minutes. If necessary, the drug is administered repeatedly every 5–10 minutes until a therapeutic effect is achieved under constant electrocardiographic control. To maintain the antiarrhythmic effect, 50-100 mg are administered orally 4 times a day. Difenin is contraindicated in severe sinus bradycardia, sinoatrial blockade, complete atrioventricular blockade.

5. Bretylium tosylate is administered at a dose of 400-600 mg intramuscularly. The action occurs after 15 minutes, the maximum effect after 2-3 hours, the duration of action is up to 20 hours. The drug does not change or increases atrioventricular conduction and enhances myocardial contractility.

6. With a sharp digitalis bradycardia and violations of atrioventricular conduction, intravenous or subcutaneous administration of atropine at a dose of 0.5–1 mg every 4 hours is indicated. minute and there are disturbances in the blood supply to the brain, an increase in angina attacks and an increase in heart failure.

In the absence of the effect of atropine in supraventricular bradycardia, temporary transvenous pacing with a "demand" pacemaker can be used.

With complete atrioventricular block and incomplete atrioventricular block II degree, atropine is less effective. The use of drugs such as isoprenaline should be avoided due to the risk of severe ventricular tachyarrhythmias. With Adams-Stokes-Morgagni syndrome or the danger of its occurrence (complete atrioventricular block with severe bradycardia), temporary pacing is indicated.

II group of drugs used in the treatment of intoxication with cardiac glycosides:

The second group of drugs includes drugs used for glycoside intoxication with ectopic heart rhythm disturbances and the absence of blockades. Appoint:

1. Potassium preparations. Potassium chloride is used orally up to 6-8 g / day in solution or intravenously at the rate of 1.0-1.5 g of the drug in 0.5 l of isotonic glucose solution with 4-8 units of insulin (polarizing mixture). It is administered drip for 3 hours under electrocardiographic control in order to timely detect possible hyperkalemia (appearance of pointed T waves, disappearance of P waves, conduction disturbances). Panangin is administered orally up to 6 tablets per day or intravenously 1-3 ampoules (10-30 ml) in 150-200 ml of isotonic sodium chloride solution or as part of a polarizing mixture (150-200 ml of 5% glucose solution and 4-8 units of insulin) .

2. Lidocaine is administered intravenously by stream (80-120 mg over 5-10 minutes). Since the effect of lidocaine with an intravenous jet method of administration lasts about 30 minutes, if necessary, treatment is continued by drip intravenous injection of 500 mg of lidocaine in 500 ml of 5% glucose solution at a rate of 40–50 drops (1–2 mg of lidocaine) per minute.

3. Etmozin - a drug of quinidine-like action is administered intravenously in a stream of 2-4 ml of a 2.5% solution in an isotonic sodium chloride solution (for 5-7 minutes), as well as intramuscularly. Inside prescribed in tablets of 25 mg (up to 150-300 mg / day).

4. Isoptin (verapamil) is most effective in supraventricular tachycardia and tachyarrhythmias. Intravenously administered at a dose of 5-10 mg for 20-30 seconds. For maintenance treatment and in milder cases of digitalis arrhythmia (extrasystole), isoptin is used orally at a dose of 40-80 mg 3 times a day.

5. If nausea and vomiting occur as a result of glycoside intoxication, metoclopramide (raglan; cerucal) is used 10 mg 3 times a day intramuscularly.

Description:

The state that develops as a result toxic effects cardiac glycosides. can occur both against the background of an overdose and at a normal concentration of digitalis preparations in the blood plasma (for example, when most of the cardiac glycosides circulate in a free state, which causes more fast development toxic effects). The course is usually acute, rarely chronic. Statistical data. The frequency is 5–23% of patients taking digitalis preparations and other cardiac glycosides.

Symptoms:

Symptoms of rhythm disturbance: (especially non-paroxysmal tachycardia from the atrioventricular node), occurring after a period of normalization of heart rate or bradycardia; , ventricular (especially bigeminia); ventricular tachycardia (including multifocal); (seldom). It must be remembered that while maintaining tachycardia in a patient taking cardiac glycosides, their overdose must be excluded.

Symptoms of conduction disorders: AV blocks various degrees; sinoatrial blockade.

Symptoms of gastrointestinal dysfunction: anorexia, abdominal pain,.

Symptoms of dysfunction of the central nervous system: headache, nightmares, decreased visual acuity, impaired color vision(yellow or green spots before the eyes), blindness.

ECG signs: trough-shaped depression of the ST segment; prolongation of the P–Q interval >0.20 s; decrease in amplitude, inversion of the T wave; shortening of the QT interval; sudden disruption heart rate against the background of taking SG: sinus bradycardia, atrioventricular, atrial or ventricular extrasystoles (often allorhythmia in the form of bigeminy or trigeminy), non-paroxysmal tachycardia from the atrioventricular node, (rarely), AV blockade of the II degree in the Samoilov-Wenckebach periodicals, blockade of the legs of the bundle of His, atrial tachycardia with AV block, bidirectional ventricular tachycardia (QRS complexes on the ECG are alternately positive and negative).

Laboratory tests: Elevated levels of SG in the blood (for digoxin >2 ng/ml [>5.1 nmol/l], for digitoxin >35 ng/ml), .

Causes of occurrence:

Overdose of cardiac glycosides (including suicidal attempts). Poisoning by plants containing cardiac glycosides.
Risk factors:
- Hypoxia
- Hypokalemia (including when taking diuretics that remove potassium from the body)
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- Myocardial infarction
- Postinfarction
- Transferred in the past
- hepatic or
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- Electrical cardioversion
- Elderly age
- Hypoproteinemia (including due to insufficient income with protein food)
- Co-administration of cardiac glycosides and quinidine, verapamil, amiodarone, propafenone.

Treatment:

For treatment appoint:

Lead tactics. Mode - stationary with limitation physical activity, the abolition of cardiac glycosides. Maintaining the optimal concentration of electrolytes in blood plasma (potassium - at the upper limit of the norm: 5.5 mmol / l). Avoid the use of quinidine, which increases the plasma concentration of digitalis by releasing it from bound state and reducing renal and extrarenal excretion of the drug, as well as b-blockers and b-adrenergic agonists. Temporary transvenous pacemaker if necessary (in cases of severe bradycardia, complete AV blockade with Morgagni-Adams-Stokes attacks).

Drug Therapy:

With bradycardia - atropine.
In case of intoxication against the background of hypokalemia - potassium preparations, for example, potassium chloride orally or intravenously as part of a polarizing mixture (potassium chloride 2 g, insulin 6 units, 5% glucose solution 350 ml; potassium chloride 4 g, insulin 8 units, 10% glucose solution 250 ml). When taking the drug orally in patients with dilatation of the left atrium or in the treatment of anticholinergics, the risk of ulceration of the mucous membrane of the esophagus and stomach is increased.
With tachycardia, in addition to potassium preparations, it is possible to prescribe b-blockers.
For ventricular arrhythmias - lidocaine 50-100 mg IV over 3-4 minutes, if necessary, repeat every 5 minutes to a total dose of 300 mg / h, or infusion at a rate of 20-50 mcg / kg / min. Magnesium preparations are indicated for each patient with suspected digitalis intoxication in the absence and without impaired renal function.
To accelerate the excretion of the glycoside - activated charcoal 25 g every 4 hours for 40 hours.
acidosis correction. The course and prognosis are favorable after 24 hours from the first signs of intoxication.
Observation: frequent ECG, determination of concentrations of potassium and cardiac glycosides in blood plasma, monitoring of kidney function.

Prevention: Careful monitoring of the patient taking SG. Monitoring the concentration of potassium in the blood plasma. Complete nutrition.

In acute poisoning, the heart muscle it is affected very often, and with severe intoxication, as a rule. At the same time, myocardial dystrophy is the basis of the pathological process. In some cases, myocardial dystrophy can be associated with the direct effect of the poison on metabolic processes in the myocardium (specific cardiotoxic effect), in others - with the indirect influence of disorders that occur in the body during intoxication (nonspecific cardiotoxic effect). The latter include hypoxic conditions, circulatory disorders (shock, collapse), disorders of the acid-base state, water-salt balance, vitamin deficiency, an increase in catecholamines, an increased load on the heart muscle, etc. The significance of each of these causes may be different depending on the nature of the poison, the severity of intoxication and the accompanying complications.

With many intoxications the main factor leading to myocardial dystrophy are hypoxic conditions. They can be in the nature of hypoxic hypoxia (poisoning with narcotic and suffocating substances, etc.), hemic (poisoning with carbon monoxide and methemoglobin formers), tissue (poisoning with cyanides) and circulatory. The latter are observed in a variety of severe intoxications and most often manifest as intoxication shock. If intoxication is accompanied by hepatic or kidney failure, then in the pathogenesis of myocardial dystrophy great importance acquire autointoxication, electrolyte and water balance disorders; acidosis, etc.

Myocardial dystrophy may be exacerbated by intoxication increased work heart (with psychomotor agitation, prolonged tachycardia, increased pressure in small or big circle blood circulation), as well as with various infectious complications, among which pneumonia occupies a prominent place.

Based on the pathological process with myocardial dystrophy, there is a violation of the activity of redox processes in the myocardium. The prognosis for myocardial dystrophy is largely determined by the nature of the poison, the degree of intoxication and the ongoing therapeutic measures. In some cases, myocardial dystrophy disappears a few days after the cessation of intoxication, in others - after many weeks.

With severe intoxications in almost all cases, the cardiotoxic effect of the poison manifests itself to one degree or another (for example, in case of poisoning with chlorinated hydrocarbons, vinegar essence, sleeping pills, etc.). Among the substances that can cause poisoning are pharmacological preparations, chemical compounds, poisons of animal and vegetable origin, which have a pronounced cardiotoxic effect. These substances include cardiac glycosides, quinine and quinidine, pahikarpin; plant alkaloids - muscarine (fly agaric mushrooms), veratrin (hellenic hellebore), coniine (hemlock), aconite (Issyk-Kul root), etc. Organophosphorus compounds have a pronounced cardiotoxic effect.

In case of poisoning with cardiotoxic substances pathological process in myocardium becomes leading and is accompanied by disturbances in rhythm, conduction and contractility of the heart; with severe intoxication, sudden death can occur with clinical picture cardiogenic shock.

Intoxication with cardiac glycosides is a severe poisoning that occurs among people with pathologies of the heart muscle, since they are the only ones taking digitalis (digitalis) preparations.

The greatest sensitivity to drugs of this group is observed among the elderly, as well as patients with diseases of the excretory and circulatory system, thyroid gland.

The toxicity of cardiac glycosides increases in the case of hypomagnesemia and hypokalemia.

The development of acute intoxication with cardiac glycosides is possible regardless of the ways they enter the human body (by mouth or by injection).

Digitalis intoxication most often occurs while taking Digoxin, as it is the most used medication among cardiac glycosides. Much less often, and only in a hospital, they use Digitoxin, Celanide.

The drugs of the presented group have a rather narrow "therapeutic window", i.e. even a minimal overdose can provoke very serious consequences, cause severe poisoning with a possible fatal outcome. Symptoms of poisoning occur already when therapeutic dose twice, and an increase in this dose by 5-10 times creates the danger of death.

Digitalis preparations have cumulative properties. They bind to plasma proteins and then stay in the bloodstream for a long time.

Digitalis intoxication can occur for the following reasons:

• excess of the therapeutic dose of the drug;
• advanced age;
• severe degrees of renal and hepatic insufficiency;
• diseases of cardio-vascular system: myocarditis, ischemic disease hearts, transferred operations and etc.;
• low levels of potassium in the blood plasma, which occurs due to the use of diuretics, and sometimes with a secondary form of hyperaldosteronism;
• the presence of an imbalance of other trace elements (hypomagnesemia, hypercalcemia);
• conditions that provoke hypoxia: lung disease and heart failure;
• the use of antiarrhythmic drugs - Cordarone, Verapamil, Quinidine;
• the use of macrolide antibiotics;
• diseases of the thyroid gland with an increase in the synthesis of its hormones.

With intoxication with these drugs, a powerful imbalance of electrolytes in the heart cells occurs. They accumulate calcium and sodium, but the amount of potassium is significantly reduced. Such transformations lead to an increase in the strength of heart contractions. At the same time, Digoxin reduces the speed of impulses passing through the conduction system of the heart. These changes lead to the development of digitalis intoxication.

Clinical picture of poisoning

The first signs of intoxication with digitalis preparations are detected on the ECG, when the clinic of poisoning is still absent. The electrocardiogram demonstrates a variety of cardiac arrhythmias:

• tachycardia (increased heart rate);
• blockades;
• extrasystole (extraordinary myocardial contractions);
• fibrillation ("flutter") of the ventricles and atria.

Other changes are observed, but only qualified doctors can detect them. If not start help on early stage intoxication, clinical symptoms will also begin to appear.

There are several groups of clinical signs.

Symptoms of damage to the heart muscle:

• arrhythmia, cardiac arrest;
• signs of ischemia (intense retrosternal pain).

Gastrointestinal tract injury:

• diarrhea;
• lack of appetite;
• vomit;
• nausea.

Neurological changes:

• insomnia;
• fatigue and weakness;
• dizziness;
• psychosis;
• depression;
• migraine.

Damage to the organs of vision:

• dots and spots before the eyes;
• violation of the perception of colors (yellow-green tones predominate);
• fear of bright light;
• fuzzy and blurry image;
• blindness.

The acute form of poisoning is characterized by the rapid (a few minutes or hours after the use of Digoxin) development of a pronounced clinic. At the same time, the patient's condition deteriorates sharply, which is accompanied by convulsions, a fall blood pressure and cardiac arrest.

Video

The specifics of the treatment of poisoning with cardiac glycosides

In case of intoxication with Digoxin, it is important to provide first aid in time and start treatment. As for therapy, it consists of a corresponding number of important measures:

• cancellation of cardiac glycosides;
• removing toxins from human body. For this, it is necessary to take the appropriate sorbents: activated charcoal, Polysorb, Smektu, Atoxil, etc. Then the stomach should be washed, but this is done only in emergency cases. Sometimes saline laxatives are used: sodium or magnesium sulfate, as well as Karlovy Vary salt;
• in severe cases, potassium chloride is administered intravenously, and in lighter cases, inside, but only after eating;
• choice of arrhythmic medicines depends on the type of arrhythmia;
• specific antidotes for cardiac glycosides are Digitalis antidote BM and Unithiol;
• in rare cases, pacing is performed;
• symptomatic therapy includes intravenous administration saline and glucose, the use of psychotropic drugs, as well as oxygen therapy.

Prevention of digitalis intoxication

Prevention of poisoning with digitalis preparations consists in careful selection of the dose of the drug. Take glycosides only as prescribed by a doctor!

The course of treatment should be accompanied by constant monitoring of the dynamics of the ECG, as well as the level of electrolytes in the blood (the most important control of the concentration of potassium).

The patient must inform the cardiologist about the drugs that he takes for treatment concomitant diseases(antibiotics, diuretics, antiarrhythmics, etc.).

Be sure to include in the diet foods rich in potassium (dried apricots, prunes, raisins, potatoes in their skins).

Thus, poisoning with cardiac glycosides is a very dangerous and insidious phenomenon. If timely assistance is not provided and therapy is not started, a person may die due to a stop in the activity of the heart muscle.

Cardiac (including cyanogenic) glycosides are medications vegetable origin, with therapeutic effect and toxicity at the same time. In case of overdose, digitalis intoxication with cardiac glycosides may occur.

Digitalis intoxication occurs with excessive intake of "digitalis" - drugs that are part of the group of medicines for the heart. They are prescribed in the treatment of chronic arrhythmias, heart failure. Digitalis, Digitoxin, Digoxin are produced from the components of the foxglove plant.

Taking drugs can cause poisoning if there are health conditions:

• elderly age;
• disorders of the thyroid gland;
• diseases of excretory organs - liver and kidneys;
• imbalance of minerals in the blood (lack of potassium, excess calcium) after taking diuretics;
• hypoxia (lack of oxygen) caused by acute cardiac, respiratory failure;
• post-infarction condition, heart surgery, any pathology.

A feature of treatment with cardiac glycosides is their long circulation in the blood. Digitalis preparations provoke an increase in contractions, an imbalance in the work of the heart occurs. Glycoside intoxication occurs, especially in the presence of problems with the kidneys and liver.

Symptoms of glycoside intoxication

The manifestation of symptoms depends on the degree of poisoning, they can be of different intensity. Signs of poisoning:

1. Cardiac symptoms: severe angina pectoris - squeezing, burning pain in the region of the heart, passing without medication in 10-15 minutes. There is an arrhythmia, a clear feeling of interruptions in the work of the heart.
2. Work failures digestive system: abdominal pain, lack of appetite, diarrhea, vomiting, nausea.
3. Headaches, migraine, anxiety, drowsiness, apathy.
4. The appearance of "flies" in the eyes, lowering the level of vision up to blindness.
5. A strong drop in blood pressure.
6. Severe signs of severe glycoside intoxication: epileptic convulsions, including in an unconscious state; severe damage to the central nervous system, falling into a coma, death.

Intoxication in severe form causes an immediate cessation of the heart.

During long-term treatment digitalis preparations, patients periodically take a blood test that shows the concentration of cardiac glycosides in plasma.

With cardiac symptoms, poisoning with digitalis, digoxin is diagnosed after an electrocardiogram. It is especially important to prescribe an ECG at an early stage of intoxication, glycoside poisoning can be chronic or acute.

Symptoms of chronic intoxication differ from acute poisoning less intensity, more difficult to detect. An electrocardiographic study should show what the cardiac mechanism of action of digoxin is in certain areas of the heart.

Rules for the provision of emergency care

The more acute the signs of poisoning are, the more severe the degree of intoxication of the patient, whose condition may worsen every minute. In such cases, it is required emergency help, the use of antidotes and antidotes. If there are signs of an overdose, it is necessary to urgently call ambulance, while waiting for which you can provide feasible measures at home:

• urgent discontinuation of glycosides, in mild cases of poisoning - dose reduction;
• inducing vomiting after a large number drunk water;
• elimination of toxins through the use saline solutions, receiving activated carbon, other adsorbents. Gastrointestinal lavage is performed in extreme cases and under medical supervision;
• give the patient a warm sweet drink to drink, put him in a ventilated room;
• in an unconscious state, turn the patient's head to one side so that he does not suffocate with vomit.

First aid to eliminate the consequences of poisoning with cardiac glycosides includes measures:

1. Multiple ECG for accurate diagnosis of the patient's condition, severity, recovery after an overdose.
2. The use of potassium, magnesium preparations, in severe conditions - intravenously.
3. After identifying the type of arrhythmia, antiarrhythmic drugs are prescribed.
4. The appointment of special antidotes, the dose of which is prescribed by the doctor.
5. Cardiac pacing in emergency cases.

In severe poisoning, hemodialysis is performed - a special procedure that cleanses the blood of toxins using an artificial kidney apparatus.

Providing rest to the patient and careful observation.

Antidote use

According to the International Classification of Diseases (ICD), cardiac glycoside poisoning is classified under the code T 46.0.

To eliminate the consequences of acute intoxication, the patient is prescribed an antidote of cardiac glycosides. The therapy consists in binding free digoxin in the blood plasma, stopping its effect on cardiac cells.

Antidote - fragments of special, specific antibodies that work against digitalis, which are formed in the body of sheep. Studying the pathogenesis of intoxication, scientists came to the conclusion that these antibodies are related to digoxin molecules. There are compounds at the molecular level with protein and a gradual withdrawal from the body.

Due to the risk of allergic reaction, with caution prescribe a digitalis antidote to people who cannot tolerate protein: chicken or sheep.

Assign an antidote in a dose proportional to the dose of absorbed digitalis glycoside. The instructions for the antidote contain a formula for calculating the dosage. The most famous digitalis antagonists are: Difenin, Digibind, Unitiol, Digitalis antidote BM.

Overview of drugs used for intoxication with cardiac glycosides

While the patient is in the clinic to eliminate the consequences of an overdose of cardiac glycosides, he is individually prescribed drugs that restore the body. Treatment depends on many factors: age, timing of drug use, the functioning of the liver, kidneys, the presence of chronic diseases.

Without fail, after taking an antidote (the appointment of an antidote depends on the severity of intoxication), toxins are removed by adsorbents: activated carbon, Enterosgel, Sorbeks. Other drugs prescribed for poisoning may include:

• to eliminate hypokalemia, replenish potassium in cardio organs, against dehydration - potassium chloride, insulin, glucose, Panangin, potassium orotate, Asparkam;
• with bradycardia (slow pulse), vomiting, nausea - Atropine, which increases heart rate. It must be borne in mind that Atropine is contraindicated in tachycardia, as is the use of adrenaline (to avoid ventricular fibrillation);
• magnesium sulfate preparation, provided that there are no disturbances in the functioning of the kidneys;
• for the formation and excretion of calcium compounds that disrupt the functioning of blood vessels - Trilon B, citrate salts;
• to stop arrhythmia - Propranolol, Lidocaine, Anaprilin, Novocainomide. Eliminates ventricular arrhythmias Phenytoin;
• appoint if necessary anticonvulsants Aminosine, sodium hydroxybutyrate, Sibazon;
• carry out oxygen therapy, eliminating oxygen starvation of organs;
• prescribe vitamin therapy with vitamin E, group B, to maintain the cardiovascular system Riboxin, Aspicard.

Possible complications and prevention

Digitalis digitalis cardiac glycosides have been successfully used in the treatment of cardiac disorders. The main recommendations are an ECG, monitoring of potassium levels, observation by specialists. The benefits of treatment with digitalis greatly outweigh the risks of poisoning. When taken properly, the risk of intoxication is about 5%. Preparations are prescribed even for pregnant, lactating women under the supervision of the condition of the child and mother.

Basic preventive measure possible poisoning with cardiac glycosides is compliance with the dosage of digitalis preparations. The timing of the use of glycosides is important because of their ability to accumulate.

During the reception, careful monitoring of well-being is necessary. You need to eat foods containing potassium: dried apricots, dates, raisins, new potatoes.

If symptoms of poisoning are found, seek medical attention immediately.