Related Experiment Videos
[Clinical and pharmacokinetic studies in patients with digitalis intoxication (author's transl)]
Insights
Severe digitalis intoxication in six patients led to arrhythmias and heart blocks. Stomach lavage proved effective in reducing lanatosid C absorption, confirming minimal enteral absorption with chosen therapy.
Area of Science:
- Cardiology
- Clinical Pharmacology
Background:
- Digitalis glycosides like digoxin and lanatosid C are crucial for treating heart failure and arrhythmias.
- Overdosing can lead to severe toxicity, including cardiac arrhythmias and conduction abnormalities.
Observation:
- Six patients with severe digitalis intoxication were admitted to a coronary care unit.
- Two patients ingested lanatosid C and four ingested digoxin.
- Observed toxic effects included ventricular arrhythmias, sinoatrial (SA) block, and atrioventricular (A-V) block.
Findings:
- Maximum digoxin blood levels ranged from 3.4 to 20 ng/ml.
- Peak drug levels were delayed, occurring up to 52 hours post-ingestion for lanatosid C and 12.5 hours for digoxin.
- Elevated plasma potassium levels were noted in four patients.
Implications:
- Early intervention with stomach lavage can significantly reduce the absorption of digitalis glycosides.
- Effective management involves antiarrhythmic and electrolyte therapies.
- Understanding absorption kinetics is crucial for managing digitalis toxicity.
Abstract:
6 patients with severe digitalis intoxication were studied while hospitalised in a coronary care unit. 2 and 4 patients had ingested high doses of lanatosid C and digoxin, respectively. In three cases ventricular arrhythmias, in one of these and two further cases SA blocking and an additional A-V-block in one case were observed. Maximum blood levels of digoxin between 3.4 and 20 ng/ml were determined several hours after the ingestion. The maximal blood levels were achieved in one patient only 52 h after ingesting lanatosid C and in one patient taking digoxin after 12.5 h. Potassium concentrations in plasma were elevated in 4 patients. Antiarrhythmic and electrolyte therapy is discussed and the usefulness of a stomach lavage for diminishing the quantity of absorbed lanatosid C is shown in one patient who had a maximal blood level of 3.4 ng/ml after taking 23.7 mg of lanatosid C. Cumulative urinary excretion of this patient was 0.68 mg within 5.5 days. This result confirms the minimal enteral absorption under the therapy chosen.