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digoksin predoz

digoksin predoz

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Published by Micija Cucu
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Published by: Micija Cucu on Jul 29, 2013
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07/29/2013

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Other diagnostic factors
suicidality
cardiovascular symptoms
1st tests to order 
ECG
digoxin serum concentration
serum potassium level
serum magnesium level
serum creatinine and urea
Acute
acute ingestion, low to moderate toxicity
activated charcoal
supportive care
with hypokalaemia
o
potassium replacement
with hyperkalaemia
o
observation ± correction of hyperkalaemia
with hypomagnesaemia
o
magnesium replacement
chronic ingestion, low to moderate toxicity
supportive care
with hypokalaemia
o
potassium replacement
with hyperkalaemia
o
observation ± correction of hyperkalaemia
with hypomagnesaemia
o
magnesium replacement
severe toxicity or haemodynamic compromise (acute or chronic toxicity)
digoxin binding
supportive care
 
with hypokalaemia
o
potassium replacement
with hyperkalaemia
o
observation ± correction of hyperkalaemia
with hypomagnesaemia
o
magnesium replacement
with symptomatic bradycardia/high-degree AV block
o
atropine
with ventricular tachyarrhythmias
o
defibrillation plus anti-arrhythmics
Ongoing
acute or chronic toxicity after initial treatment
prescription of alternative drug and discontinuation of digoxin
digoxin dose adjustment and regular monitoring
Summary
Can be acute or chronic, intentional, or accidental.
Typically presents with components of GI, constitutional, and/or cardiovascular symptoms.
Diagnosis is based on symptoms and laboratory data. At therapeutic digoxin doses (0.6-1.2 nanomol/L[0.5 to 0.9 nanograms/mL]), the ECG typically shows PR-interval prolongation and a scooped ST segment. Inoverdose, ECG also shows signs of increased automaticity (PVCs), AV nodal blockade, and slowed ventricular response.
Treatment includes digoxin-specific antibody fragments and supportive care. Lidocaine and phenytoincan be used for cardiac dysrhythmias when antibody fragments are unavailable.
There are no long-term complications of poisoning in patients treated appropriately for chronic digoxintoxicity, as long as anoxic brain injury, myocardial infarction, or terminal dysrhythmias have not occurred prior totreatment.
Definition
Digoxin is the most commonly prescribed cardioactive corticosteroid in theUS. Cardioactive corticosteroids have been used for over 200 years in thetreatment of dropsy, which is better understood today as oedema fromCHF. [1] In therapeutic doses, they increase cardiac contractility and control the heart rate. Digoxin toxicity is a clinical diagnosis that relies in part on ECGfindings such as signs of increased automaticity and AV node blockade

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