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[Hemoperfusion therapy in severe suicidal digoxin poisoning]
Abstract:
Severe digoxin intoxications have a mortality rate of about 20%. Clinical course of intoxication, electrocardiographic changes as well as the behaviour of the plasma-digoxin concentration could closely be controlled on 4 patients after suicidal ingestion of potentially lethal dilanacin -new doses. In 3 patients a haemoperfusion treatment lasting 4 to 6 hours was performed. Clinical symptoms and existing disturbances of cardiac rhythm were clearly positively influenced under perfusion. The earlier the treatment was begun the more favourably appear the effects on the course of intoxication. After an at first benign picture of intoxication in the non-perfused female patient a comparatively distinct prolonged clinical and electrocardiographic symptomatology developed. Though the digoxin extraction established by computation fairly slightly imposes, this eliminated free digoxin fraction seems, nevertheless, to possess a considerable pharmacological and clinical importance. The adsorber material used showed well reproducible high clearance performances. During the haemoperfusion treatment in no case clinical complications were observed.
Insights
Hemoperfusion effectively manages severe digoxin toxicity by improving clinical symptoms and cardiac rhythm disturbances. Early intervention with hemoperfusion leads to better patient outcomes in digoxin poisoning cases.
Area of Science:
- Pharmacology
- Toxicology
- Cardiology
Context:
- Severe digoxin intoxication presents a significant mortality risk (approx. 20%).
- Management of life-threatening digoxin overdose requires effective interventions.
- Suicidal ingestion of digoxin necessitates prompt and aggressive treatment.
Purpose:
- To evaluate the efficacy of hemoperfusion in treating severe digoxin intoxication.
- To assess the impact of hemoperfusion on clinical course, ECG changes, and plasma digoxin levels.
- To determine the optimal timing for initiating hemoperfusion in digoxin poisoning.
Summary:
- Hemoperfusion was performed on 3 out of 4 patients with severe digoxin intoxication due to suicidal overdose.
- Patients undergoing hemoperfusion showed significant improvement in clinical symptoms and cardiac arrhythmias.
- Earlier initiation of hemoperfusion correlated with more favorable clinical outcomes.
- A non-perfused patient experienced a prolonged and severe clinical and ECG course.
- The removed free digoxin fraction, though small, demonstrated significant pharmacological and clinical importance.
- The adsorber material exhibited consistent high clearance, and hemoperfusion was well-tolerated without complications.
Impact:
- Hemoperfusion is a viable and safe treatment option for severe digoxin toxicity.
- Early hemoperfusion can mitigate the severity and duration of digoxin intoxication.
- This study highlights the clinical significance of free digoxin in toxicity management.
- Findings support the integration of hemoperfusion into treatment protocols for digoxin overdose.