digitoxin and Poisoning

Cardiac glucoside intoxication is a frequent medical problem given the following: the very narrow therapeutic range, its use in advanced aged patients, in patients with altered renal function, and because of interaction with other drugs. There are two types of digitalis intoxication: one that appears as a complication of the treatment with digitalis, and the other as a result of an accidental ingestion or in suicide attempt. The objective of this study was to review and assess the level of scientific evidence on the effectiveness and the indications of use of Fab fragments of antidigoxine antibodies.. A systematic bibliographic search in the following databases was made: MEDLINE, The Cochrane Library, The Iowa Drug Information Service, Embase, LMS/R&D Insight, and Indice Médico Español. The selected papers were classified according to their level of scientific evidence.. Abstracts of 252 references were reviewed. In the reviewed bibliography no controlled, randomized trials were found. Most of the studies found are descriptions of case series or single cases that were treated with antidigoxin Fab fragments. These types of studies provide little or no scientific evidence to speak of. None of the treatment regimes with antidigoxin antibody Fab fragments so far proposed have proven to be valid in a controlled, randomized clinical trial.. There is a very high level of concordance among the studies reviewed with regards to the efficacy and the indications for the use of Fab fragments in severe acute accidental digitalis intoxication and in suicide attempts. Regarding those intoxications that result in patients undergoing digitalis therapy, usual therapeutic approach is traditional treatment and the monitorization of the severity of the intoxication.

Topics: Digitalis; Digoxin; Humans; Immunoglobulin Fab Fragments; Plants, Medicinal; Plants, Toxic; Poisoning

Although most acute pediatric ingestions of digoxin or other related cardiac glycosides result in minimal or no symptoms, occasionally a child is symptomatic. Gastrointestinal complaints or first-degree AV block are the most common presenting symptoms. Children can generally be given a single dose of activated charcoal, observed, and discharged without any subsequent problems. However, some patients will be toxic and require monitoring, medication, and possibly digoxin-specific antibody fragments. The most important role of the clinician is to recognize the clinical manifestations and institute the appropriate therapy. As in the case presented, the history of an ingestion may not always be obtained initially. Thus, the physician should maintain a high index of suspicion for acute digoxin ingestion and order the appropriate confirmatory tests (eg, a digoxin level, a potassium level, and a 12-lead ECG) when necessary.

Topics: Acute Disease; Cardiotonic Agents; Digitalis; Digoxin; Humans; Infant; Male; Plants, Medicinal; Plants, Toxic; Poisoning; United States

Topics: Digitoxin; Digoxin; Drug Interactions; Drug Monitoring; Humans; Poisoning

Topics: Antidotes; Digitalis; Digoxin; Drug Overdose; Humans; Plants, Medicinal; Plants, Toxic; Poisoning

Digitalis glycosides have a narrow margin between therapeutic and toxic levels. Although the incidence of digitalis toxicity appears to be decreasing, continuation of digoxin therapy in the face of overt toxicity carries a substantial risk of life-threatening cardiac rhythm disturbances. This review will focus primarily on toxicity produced by digoxin and discuss the mechanisms, clinical manifestations, and current management of digitalis toxicity. The appropriate methodology for measurement and interpretation of serum digoxin levels is emphasized. The varied cardiac dysrhythmias induced by digoxin are detailed and their specific management outlined. Immunological (antibody) treatment has now been established and approved for the therapy of advanced, life-threatening digitalis toxicity and the multicenter trial of digitalis antibodies is described. Proper understanding of the pharmacokinetics of digitalis glycosides and careful followup of digitalis treated patients for early evidence of toxicity should help to decrease further the prevalence of toxic reactions.

Topics: Arrhythmias, Cardiac; Digitoxin; Digoxin; Humans; Poisoning

Although the elimination of specific toxins by the removal of all plasma constituents is a crude approach, further refinements of the technique should permit safer and more selective detoxification in the future. Currently the mainstay of treatment of intoxicated patients remains careful, aggressive, supportive care. Plasmapheresis should be considered as yet an unproven, hazardous form of therapy for the treatment of intoxication. Its main role should be confined to a research setting in which investigators attempt to develop more advanced and potentially useful apheresis techniques. Membrane plasmapheresis with subsequent on-line treatment of the plasma by sorbent may remove specific plasma solutes. The plasma may be perfused back to the patient without the need to use replacement fluids, thus avoiding many of the side effects of conventional exchange. Bile acids have been removed by circulating plasma over charcoal-coated glass beads, and several toxic substances were shown to be absorbed by perfusion over amberlite resin columns. Another productive area for future research includes the use of plasma exchange therapy for the treatment of acute endogenous intoxications. Recent examples include the treatment of severe preeclampsia, extensive rhabdomyolysis, and life-threatening bleeding in a hemophiliac with inhibitors to clotting factors. Although plasmapheresis in the management of intoxications is still an experimental technique, it may open the door to the treatment of previously intractable syndromes, both medical and toxicologic.

Topics: Adult; Blood Proteins; Digitoxin; Evaluation Studies as Topic; Half-Life; Humans; Kinetics; Mushroom Poisoning; Paraquat; Plasma Exchange; Plasma Volume; Plasmapheresis; Poisoning; Toxicology

Topics: Acetaminophen; Acetylcysteine; Antidotes; Charcoal; Chemical and Drug Induced Liver Injury; Child Abuse; Child, Preschool; Digitoxin; Digoxin; Emetics; Female; Gastric Lavage; Humans; Hydrocarbons; Immunoglobulin Fab Fragments; Infant; Male; Naloxone; Narcotics; Poisoning

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Atrioventricular Node; Diagnosis, Differential; Digitalis Glycosides; Digitoxin; Digoxin; Heart Diseases; Heart Rate; Heart Ventricles; Humans; Myocardium; Poisoning; Radioimmunoassay

Topics: Anorexia Nervosa; Color Vision Defects; Digitalis Glycosides; Digitoxin; Digoxin; Eye Manifestations; Fatigue; Humans; Medication Errors; Mental Disorders; Muscular Diseases; Nausea; Neurologic Manifestations; Poisoning; Vision Disorders

Because life-threatening digitalis intoxication is unusual in children, treatment with digoxin-specific-antibody Fab fragments (Fab) has rarely been reported. We describe the efficacy of Fab in the treatment of children with severe digitalis intoxication.. Twenty-nine children with intoxication due to digoxin (28) or digitoxin (1) received Fab at 21 participating hospitals between 1974 and 1986. Data were gathered about the patients' medical illnesses, doses and serum concentrations of digitalis, responses to Fab therapy, and outcomes.. In the infants and young children with acute digoxin intoxication, the digoxin doses ranged from 0.30 to 0.96 mg per kilogram of body weight; two adolescents had severe intoxication after doses of only 0.20 and 0.26 mg per kilogram. The serum digoxin concentrations ranged from 3.0 to greater than 100 ng per milliliter (mean, 13.8). Atrioventricular block (present in 22 patients [76 percent]) was the most common sign of toxicity. All the patients in this series had severe disturbances of cardiac rhythm, hyperkalemia (mean serum potassium concentration, 5.4 mmol per liter), or both. In 27 patients (93 percent), digitalis toxicity resolved after the administration of Fab. Of the 19 patients for whom data were available on the timing of the response to Fab, 15 responded within 180 minutes. Three patients required retreatment with Fab. Seven died of complications unrelated to the administration of Fab.. We recommend that Fab be used in the treatment of digitalis poisoning in infants and young children who have ingested greater than or equal to 0.3 mg of digoxin per kilogram, who have underlying heart disease, or who have a serum digoxin concentration of greater than or equal to 6.4 nmol per liter (greater than or equal to 5.0 ng per milliliter) in the elimination phase; and who also have a life-threatening arrhythmia, hemodynamic instability, hyperkalemia, or rapidly progressive toxicity. Adolescents, who are more sensitive to the toxic effects of digoxin than younger children, may require treatment with Fab after ingesting lower doses.

Topics: Acute Disease; Adolescent; Arrhythmias, Cardiac; Child, Preschool; Digitoxin; Digoxin; Female; Heart Block; Heart Diseases; Humans; Hyperkalemia; Immunoglobulin Fab Fragments; Infant; Infant, Newborn; Male; Poisoning

Advanced Digitalis intoxication is a rare event, mainly associated with overdose in patients with Digitalis therapy. We report an unusual case of acute 'familiar' digitalis poisoning in three patients who had eaten potato dumplings flavoured with leaves of Borago officinalis L. unconsciously mixed with leaves of Digitalis purpurea L. A complicated clinical course with marked bradyarrhythmias was presented, with good evolution thanks to the use of digoxin-specific antibody Fab fragments. The theme of the domestic use of plants with medicinal effects has been treated and discussed.

Topics: Acute Disease; Adult; Antidotes; Bradycardia; Cardiac Glycosides; Charcoal; Digitalis; Electrocardiography; Female; Food Contamination; Heart Rate; Humans; Immunoglobulin Fab Fragments; Male; Middle Aged; Plant Leaves; Poisoning

Despite administration of Fab fragments in digitalis poisoning, high mortality rates are consistently reported. A previous study suggested that Fab fragments prescribed as first-line therapy might improve mortality rate. Our objective was to evaluate this approach.. Retrospective chart review (January 1990 to January 2004).. University hospital intensive care unit.. Consecutive patients admitted for cardiac glycoside poisoning.. First-line therapy with Fab fragments (with or without atropine) in either curative or prophylactic doses.. A total of 141 patients were admitted for digitalis poisoning of whom 66 received first-line Fab fragment therapy. Their median age was 74 years (25th to 75th percentiles: 51-83); 76% were women. Half were intoxicated by digitoxin and half by digoxin. Median serum concentration was 168 (108-205) ng/mL for digitoxin and 6.2 (4.3-13.5) ng/mL for digoxin. Conduction disturbances were reported in 45 cases (68%) and ventricular arrhythmia in six cases (9%). Fab fragments were administered as curative treatment in 21 patients (32%) and prophylactically in 45 patients (68%). The median cumulative dose was 4 (4-6) vials. No adverse effects were reported. Five patients (7.6%) died.. First-line therapy with Fab fragments in patients with digitalis poisoning was associated with a low mortality rate.

Topics: Aged; Aged, 80 and over; Arrhythmias, Cardiac; Atropine; Cardiotonic Agents; Critical Care; Digitalis Glycosides; Digitoxin; Digoxin; Female; Humans; Immunoglobulin Fab Fragments; Male; Middle Aged; Poisoning; Retrospective Studies

Because of the paucity of information on the epidemiology of acute poisoning requiring intensive medical care, all such patients treated on the medical intensive care unit of the university hospital in Frankfurt am Main, Germany, between January 1993 and December 1999, were retrospectively evaluated.. Of the total of 6211 patients, 147 (80 women, 67 men, mean age 41 years, 2,3 %) were treated for acute intoxication in the intensive care unit.. Reasons for admission to the intensive care unit were the need for ventilator treatment or intensive monitoring of vital functions. 52 % of the patients (n = 76) had attempted suicide, most of them using anti-depressive drugs (n = 19), paracetamol (n = 16), or benzodiazepines (n = 9). Two patients (2,6 %) died. 48 % of the patients (n = 71) were admitted because of accidental poisoning. Leading toxic agents in this group were heroin (n = 19), alcohol (n = 18) and digitalis (n = 12). 11 patients had taken herbicides, animal poisons or chemicals used at work or for house cleaning. In this cohort, three i. v. drug abusers (4,2 %) had died. Depending on the agents used, a variety of treatments (charcoal, antidots, extracorporal therapy) were undertaken.. Due to excellent care in the prehospital phase and in the emergency room the number of patients requiring treatment on the intensive care unit was rather low. The mortality was in the range of other reports.

Topics: Accidents; Acetaminophen; Acute Disease; Adult; Analgesics, Non-Narcotic; Antidepressive Agents; Antidotes; Benzodiazepines; Charcoal; Cohort Studies; Digitalis; Emergency Medical Services; Emergency Service, Hospital; Female; Germany; Herbicides; Hospitals, University; Household Products; Humans; Intensive Care Units; Male; Monitoring, Physiologic; Poisoning; Respiration, Artificial; Retrospective Studies; Sex Factors; Suicide, Attempted

Topics: Adult; Bradycardia; Cardiotonic Agents; Chest Pain; Diagnosis, Differential; Digitoxin; Electrocardiography; Heart Block; Humans; Male; Myocardial Infarction; Poisoning; Suicide, Attempted

A 85 year old female was hospitalized because of a bronchopulmonary infection. During the hospitalization she developed a progressive stupor. There was no sign of an intracerebral pathology, an electrolyte disorder, a new infection or a psychiatric diagnosis. Evaluation of the past history made a recently started digitalis medication responsible for the stupor. After discontinuation of digitalis the patient regained complete consciousness within two weeks. In the Holter-EKG we found once an asystole of four seconds duration without any symptoms.

Topics: Aged; Aged, 80 and over; Asthenia; Digitalis; Female; Humans; Motivation; Plants, Medicinal; Plants, Toxic; Poisoning

Topics: Aged; Digitalis; Female; Humans; Plants, Medicinal; Plants, Toxic; Poisoning

A 22-year-old man presented to our emergency department after an intentional overdose of a homemade foxglove extract. Clinical symptoms with symptomatic bradyarrhythmia and ECG changes were consistent with cardiac glycoside poisoning. Treatment with digoxin-specific Fab fragments resulted in transient clinical and ECG improvement. Serum immunoassay demonstrated a digitoxin-like glycoside. The serum levels showed no evidence of altered elimination or distribution with Fab therapy despite temporary improvements in the clinical course. The use of Fab did not result in a shortened clinical course in this episode of foxglove poisoning, as one would expect in the setting of commercial glycoside product poisoning.

Topics: Adult; Digitalis; Digitoxin; Digoxin; Half-Life; Humans; Immunoglobulin Fab Fragments; Male; Plant Extracts; Plants, Medicinal; Plants, Toxic; Poisoning; Suicide, Attempted

Topics: Digitoxin; Humans; Male; Middle Aged; Poisoning; Suicide, Attempted; Tablets; Thrombocytopenia

Postmortem digitoxin levels in the choroid-retina and vitreous humor of patients who had undergone digitoxin therapy (therapeutic group) and in one case of suicidal digitoxin poisoning were measured and compared with levels in femoral vein blood, myocardium, kidney and liver. The results were interpreted in light of the medical history of each patient. The digitoxin level in the choroid-retina of the single case of suicidal poisoning was far higher than the choroid-retinal levels in the therapeutic group. In the latter, variation in choroid-retinal levels was comparable to that in the other tissues. In cases where the choroid-retina of the right and left eyes were examined, digitoxin levels in both eyes were essentially equal. There was no indication of significant changes in choroid-retinal levels due to postmortem diffusion of digitoxin into the vitreous body. Based on these results, determination of digitoxin levels in the choroid-retina could contribute to improving postmortem diagnosis of lethal digitoxin poisoning.

Topics: Adult; Aged; Aged, 80 and over; Aqueous Humor; Choroid; Digitoxin; Drug Overdose; Evaluation Studies as Topic; Female; Forensic Medicine; Humans; Kidney; Liver; Male; Middle Aged; Myocardium; Poisoning; Postmortem Changes; Retina

A massive digitoxin (DGTX) intoxication in a 36-year-old man (35 mg DGTX) was treated by prolonged and repeated i.v.-infusions of Fab fragments of anti-digitalis antibodies (FAB). Blood and urine samples were collected over a 98 h period for monitoring the efficacy and adequacy of FAB treatment. DGTX concentrations were determined after protein precipitation (release of FAB-bound and protein-bound DGTX) in unprocessed serum and urine samples, and after aliquots of these samples had been dialysed in vitro against DGTX-free buffer (elimination of DGTX not bound to FAB). The difference in DGTX concentration between the unprocessed and dialysed samples was the amount of DGTX bound to plasma proteins and the small fraction of unbound DGTX being relevant for the therapeutic and toxic effects of the drug. Before FAB therapy was started, the total serum DGTX concentration was 535 nmol/l. The first FAB infusion (320 mg) was started 11 h after drug ingestion. Since this amount of FAB was insufficient to bind all DGTX present in the serum, cardiac DGTX toxicity (total AV-block) persisted. During a second FAB infusion (400 mg) the patient reverted to regular AV-conduction. At this time most of the DGTX in serum was FAB-bound. Toxic symptoms (sinus arrest) reappeared twice and were accompanied by increasing amounts of non-antibody-bound DGTX in the serum. Additional application of FAB (2 x 80 mg) resulted in the immediate disappearance of arrhythmia. During FAB-treatment total DGTX serum concentrations and renal DGTX clearance rose, indicating redistribution of drug from tissue to serum and urinary elimination of FAB-bound DGTX, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Antibodies, Anti-Idiotypic; Digitalis; Digitoxin; Electrophoresis, Polyacrylamide Gel; Humans; Immunoglobulin Fab Fragments; Infusions, Intravenous; Male; Metabolic Clearance Rate; Plants, Medicinal; Plants, Toxic; Poisoning; Suicide, Attempted

Because she felt unwell, an 80-year-old woman who was receiving treatment with digitoxin (0.07 mg daily) raised the dose on her own initiative to twice or three times the previous level. She then experienced faintness, visual abnormalities and bradyarrhythmia (rate about 40/min). The ECG showed 2 degrees AV block. The digitoxin level was 70.8 ng/ml--far above the upper limit of the therapeutic range (7.5-25 ng/ml). One striking abnormality was thrombocytopenia (33,000/microliters), though the white and red cell counts were normal. Petechiae were not present and there was no evidence of internal bleeding. As the AV block had not produced any critical fall in ventricular rate, there was no need to start treatment with digitalis-binding antibody fragments (Fab fragments). Instead, the patient was given cholestyramine 4 g three times daily with the aim of interrupting the enterohepatic circulation of digitoxin. From then on the rise in platelet count paralleled the fall in digitoxin level. Seven days after discontinuing digitoxin the platelet count reentered the normal range (147,000/microliters). However, the digitoxin level (39.5 mg/ml) was still well above the therapeutic range.

Topics: Aged; Aged, 80 and over; Cholestyramine Resin; Diagnosis, Differential; Digitoxin; Electrocardiography; Female; Humans; Poisoning; Thrombocytopenia

Topics: Animals; Antidotes; Digitalis; Digoxin; Humans; Plants, Medicinal; Plants, Toxic; Poisoning; Rats

Topics: Bradycardia; Digitalis; Gastric Lavage; Humans; Pacemaker, Artificial; Plants, Medicinal; Plants, Toxic; Poisoning

Life-threatening digitalis intoxication is treated using digoxin specific antibody fragments (Fab) that bind and inactivate the drug. The free digoxin serum concentration could be useful in the management of Fab-treated patients, but the standard methods of measurement can be clinically misleading because Fab anti-digoxin interferes with digitalis immunoassay measurements. A case involving Fab therapy of a digoxin overdosed patient, in which two laboratory methods gave very different results, is reported. The radioimmunologic assay (RIA), widely used in laboratories, yielded high values without relation to true serum free digoxin concentration. On the contrary, the recently introduced fluoroenzymatic sequential immunoassay (FEIA), which accurately measures free glycoside concentration, was a valuable aid in monitoring Fab treatment. Therefore, cardiologists' knowledge of a possible interference of specific anti-digoxin fragment treatment with many immunoassays may greatly enhance the rational management of these patients.

Topics: Acute Disease; Aged; Digitalis; Digoxin; Drug Overdose; Female; Humans; Immunoglobulin Fab Fragments; Monitoring, Physiologic; Plants, Medicinal; Plants, Toxic; Poisoning

A 50-year-old, previously healthy, woman swallowed 1 g digoxin powder, dissolved in water, with suicidal intent. On admission to hospital one hour later, having vomited three times at home, the prominent signs were somnolence and hypersalivation. Serum digoxin level was 3.37 ng/ml. There followed repeated episodes of asystole alternating with ventricular fibrillation requiring cardiopulmonary resuscitation over 90 min and adrenaline administration. Repeated electrical defibrillation, administration of dopamine, phenytoin and lidocaine, as well as transitory transvenous electrical stimulation became necessary. Anti-digoxin antibody fragments were administered, initially 80 mg, to a total of 3,280 mg over 24 hours. After 3 days of intensive care and a further 21 days in hospital she was discharged and referred to psychiatric treatment. This case demonstrates that even severe digoxin poisoning can be successfully treated without sequelae by the appropriate administration of digoxin antidote. The main problems in this case were regulation of the dosage and acquiring the necessary amount of antidote which greatly exceeded the hospital's own depot.

Topics: Acute Disease; Antidotes; Combined Modality Therapy; Digitalis; Digoxin; Drug Overdose; Drug Therapy, Combination; Female; Gastric Lavage; Humans; Middle Aged; Plants, Medicinal; Plants, Toxic; Poisoning; Powders; Suicide, Attempted; Ventricular Fibrillation

After severe acute self-poisoning by cardiac glycosides, significant and persistent depletion of red blood cell K+ due to inhibition of Na+K+ ATPase is seen. Because of a delay between the time course of plasma digitalis concentrations and that of red blood cell K+ depletion, no direct relation exists between the two, and RBC K+ has hitherto not been considered useful as prognostic indicators of clinical outcome. In an effort to solve this problem, red blood cell K+ was measured by atomic absorption spectrophotometry and plasma digitoxin concentration assayed in six patients admitted to an intensive care unit after digitoxin self-poisoning. Using the effect compartment model of Sheiner, a relationship based on a sigmoid Emax model was able to relate the digitoxin concentration at the action site to red blood cell K+ depletion. Thus the duration of red blood cell K+ depletion could be predicted from two relative simple in vitro assays. Since RBC K+ is a marker of the inhibition of Na+K+ ATPase by digitoxin, this method could be of use for the management of patients self-poisoned with digitalis.

Topics: Adult; Digitoxin; Erythrocytes; Female; Humans; Male; Middle Aged; Poisoning; Potassium; Suicide, Attempted

Although elevated digitalis concentrations are often observed, symptomatic intoxications occur less frequently. We report the course in three patients with extremely elevated digitalis concentrations as examples of the poor correlation between measured serum levels and symptoms. In view of the cost of treatment by fab-fragments and the lack of a close dose-related effect of digitalis, we suggest restricting the use of fab-fragment therapy to patients with severe hyperkalemia or hemodynamically relevant arrhythmias.

Topics: Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Digitoxin; Digoxin; Female; Humans; Immunoglobulin Fab Fragments; Male; Poisoning; Suicide, Attempted

Topics: Adult; Age Factors; Aged; Biological Availability; Cardiac Glycosides; Digitalis Glycosides; Digitoxin; Digoxin; Dose-Response Relationship, Drug; Heart Failure; Humans; Middle Aged; Poisoning; Risk

The indication to use hemoperfusion as a therapeutic measure in severe intoxications in man should be based on a three-step evaluation. First, the ability of an adsorbent to eliminate the poison from human blood has to be known. Second, the distribution volume has to be small and the spontaneous half-life of the poison has to be relatively long, such that lowering the toxic blood level results in a concomitant decreasing tissue concentration. Third, studies in poisoned patients have to prove that it is possible by hemoperfusion to lower the total body load to a toxicologically relevant extent.

Topics: Adolescent; Animals; Digitoxin; Dogs; Female; Hemoperfusion; Humans; Imipramine; Male; Metabolic Clearance Rate; Paraquat; Parathion; Poisoning; Tissue Distribution

An economical hemoperfusion system for clearance studies in vitro was developped. It was ascertained, that hemoperfusion using columns which contain 13 g of adsorbent and perfused at a blood flow rate of 1.25 ml/min results in the same relative clearances as when using clinical sized columns containing 300--355 g of the absorbent and run at 100ml/min. The adsorption kinetics of toxicologically important drugs and pesticides are given as examples. To date 27 substances were tested systematically. The investigation has shown, that no adsorbent is without exception the best one, but the efficacy can vary from substance to substance.

Topics: Adsorption; Animals; Digitoxin; Hemoperfusion; Humans; Kinetics; Methaqualone; Methyl Parathion; Paraquat; Parathion; Poisoning; Poisons; Rats

Topics: Digitoxin; Digoxin; Female; Hemoperfusion; Humans; Middle Aged; Poisoning; Protein Binding

Topics: Adult; Digitoxin; Humans; Male; Plasma Exchange; Poisoning

Sixty three sessions of haemoperfusion on coated activated charcoal were carried out in 60 cases of poisoning. The indications concerned 2 clinical situations: - massive poisoning with coma (by hypnotics or chlorine-containing solvents) with high extracellular concentrations of the toxic agent, with the aim of reducing the duration of the coma; - intoxications with a high mortality rate, such as those due to paraquat, colchicine, digitoxine, tricyclic antidepressants, and heavy metals, even when plasma levels were low in relation to the dose ingested. Such discordance may be related not only to predominantly intracellular fixation, but also to low intestinal absorption. The effectiveness of haemoperfusion was estimated in terms of the amount of toxic substance extracted, measured either indirectly by repeated calculation of the arteriovenous difference multiplied by the flow rate through the column, or directly by elution of the column. This method for the removal of toxic substances would not appear to be life-saving, is too costly for the extraction obtained and is not free from specific complications. Thrombocytopaenia remains an epiphenomenon, but the frequency of infection is significantly higher than with haemodialysis. An effective and safe method for the vascular extraction of poisons, particularly one favourising removal of toxic substances from intracellular localisation, remains to be found.

Topics: Antidepressive Agents, Tricyclic; Charcoal; Chloralose; Colchicine; Coma; Digitoxin; France; Hemoperfusion; Humans; Hypnotics and Sedatives; Paraquat; Poison Control Centers; Poisoning

Since there is no widely used causal means of reducing the severity of massive digitalis intoxication the capability of hemoperfusion with coated activated charcoal to remove toxicologically relevant amounts of digoxin and digitoxin was evaluated in vitro and in man. At a blood flow rate of 100 ml/min the digoxin clearance by hemoperfusion in vitro was 51 +/- 8 ml/min in comparison to 24.3 +/- 11.3 ml/min by hemodialysis. The average hemoperfusion clearance of digitoxin was 31.7 +/- 13.4 ml/min, whereas almost no digitoxin was removed by hemodialysis. These clearance values point to the ability of hemoperfusion of eliminating digitalis glycosides from the blood. They do not clarify the essential question whether it is possible to lower the toxic concentrations in the tissues.

Topics: Charcoal; Digitoxin; Digoxin; Hemoperfusion; Humans; Poisoning

Topics: Digitoxin; Digoxin; Heart Diseases; Humans; Magnesium; Poisoning; Radioimmunoassay; Spectrum Analysis; Uremia

Topics: Cholestyramine Resin; Digitoxin; Female; Humans; Middle Aged; Poisoning; Suicide

Topics: Alcoholic Intoxication; Barbiturates; Carbon Monoxide Poisoning; Clinical Laboratory Techniques; Digitoxin; Digoxin; Humans; Lead Poisoning; Poisoning; Salicylates

Topics: Adolescent; Adult; Aged; Digitalis Glycosides; Digitoxin; Female; Humans; Hyperkalemia; Male; Middle Aged; Poisoning; Spectrophotometry; Suicide

Topics: Adolescent; Adult; Aged; Digitalis Glycosides; Digitoxin; Female; Humans; Hyperkalemia; Male; Middle Aged; Poisoning; Spectrophotometry; Suicide

Topics: Adsorption; Animals; Antidotes; Bile; Charcoal; Cholestyramine Resin; Digitoxin; Guinea Pigs; In Vitro Techniques; Poisoning; Tritium

Topics: Acetaminophen; Adult; Amphetamine; Antidepressive Agents; Caustics; Digitalis; Fenfluramine; Humans; Male; Monoamine Oxidase Inhibitors; Phenacetin; Plants, Medicinal; Plants, Toxic; Poisoning; Salicylates

Topics: Adult; Aged; Alkaline Phosphatase; Bilirubin; Bradycardia; Cardiac Complexes, Premature; Creatinine; Digitalis Glycosides; Digitoxin; Electrocardiography; Eye Manifestations; Female; Follow-Up Studies; Gastrointestinal Diseases; Heart Block; Humans; Male; Middle Aged; Poisoning; Tachycardia

Topics: Animals; Barbiturates; Digitoxin; Ethisterone; Humans; Insecticides; Poisoning; Rats; Spironolactone; Steroids

Topics: Age Factors; Aged; Antipyrine; Digitalis; Diuretics; Drug Interactions; Drug Labeling; Drug Prescriptions; Drug Therapy; Drug Therapy, Combination; Half-Life; Humans; Phenylbutazone; Plants, Medicinal; Plants, Toxic; Poisoning; Protein Binding

To determine whether digoxin-specific antibodies can reverse established digoxin toxicity in the dog, digoxin intoxication was produced by the intramuscular administration of digoxin, 0.09 mg/kg, on each of 3 consecutive days. All animals developed toxic arrhythmias (atrioventricular block, ventricular premature contractions and/or ventricular tachycardia). In control animals not receiving antidigoxin antibodies, the arrhythmias persisted throughout a 6 hr study period. Seven of the nine control dogs were dead within 24 hr and one moribund animal was sacrificed at that time; the last animal died within 48 hr.In contrast, in six of eight dogs given digoxin-specific antibodies in canine plasma and/or rabbit serum, the arrhythmias reverted to a sinus mechanism within 30-90 min after the start of the infusion. At the end of a 6 hr period of study, these six dogs were in normal sinus rhythm and all eight were alive and in normal sinus rhythm at the end of 72 hr. This study provides evidence that digoxin-specific antibodies can reverse severe established digoxin toxicity in the dog.

Topics: Animals; Antibodies; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Digitoxin; Disease Models, Animal; Dogs; Heart Block; Hemagglutination Tests; Immunization, Passive; Poisoning; Potassium; Protein Binding; Serum Albumin; Tachycardia

Topics: Administration, Oral; Arrhythmias, Cardiac; Cardiac Glycosides; Diet Therapy; Digitoxin; Digoxin; Diuresis; Drug Tolerance; Edetic Acid; Electrocardiography; Gastrointestinal Diseases; Heart Failure; Heart Rate; Humans; Injections, Intravenous; Lanatosides; Nervous System Diseases; Phytotherapy; Plants, Medicinal; Poisoning; Potassium; Rest; Strophanthins

Topics: Accidents, Home; Animals; Animals, Domestic; Digitoxin; Humans; Infant; Poisoning

Topics: Animals; Digitoxin; Female; Indomethacin; Intestine, Small; Nitriles; Peritonitis; Poisoning; Pregnenolone; Rats; Seizures; Spironolactone

Topics: Adolescent; Adult; Aged; Digitalis Glycosides; Digitoxin; Diuresis; Electrocardiography; Female; Gastric Lavage; Humans; Lanatosides; Male; Middle Aged; Poisoning; Prognosis; Spectrophotometry, Atomic; Stomach; Suicide; Time Factors

Topics: Acute Disease; Aged; Arrhythmias, Cardiac; Coronary Disease; Digitalis Glycosides; Digitoxin; Digoxin; Electrocardiography; Female; Humans; Lung Diseases; Male; Myocardial Infarction; Poisoning; Prognosis; Prospective Studies; Radioimmunoassay

Topics: Adult; Aged; Cognition Disorders; Digitoxin; Electrocardiography; Female; Heart Block; Humans; Male; Methods; Middle Aged; Poisoning

Topics: Animals; Digitoxin; Female; Gonadal Steroid Hormones; Indomethacin; Poisoning; Rats; Steroids

Topics: Adult; Aged; Arrhythmias, Cardiac; Digitoxin; Drug Compounding; Female; Humans; Male; Medication Errors; Middle Aged; Netherlands; Poisoning

Topics: Aged; Digitoxin; Female; Hallucinations; Humans; Male; Poisoning; Psychoses, Substance-Induced

Topics: Adult; Aged; Color Perception; Digitoxin; Female; Humans; Male; Middle Aged; Poisoning; Vision Disorders

Topics: Anabolic Agents; Androstanes; Animals; Body Weight; Desoxycorticosterone; Digitoxin; Diuretics; Estradiol; Ethisterone; Ethylestrenol; Female; Fluoxymesterone; Hydrocortisone; Ketones; Methyltestosterone; Nandrolone; Norethandrolone; Norethynodrel; Organ Size; Oxandrolone; Oxymetholone; Poisoning; Pregnanes; Pregnenolone; Progesterone; Pyrazines; Rats; Spironolactone; Testosterone; Triamterene

Topics: Color Perception; Digitoxin; Drug Therapy; Eye Manifestations; Heart Diseases; Poisoning; Sensitivity and Specificity; Toxicology

Topics: Arrhythmias, Cardiac; Child; Digitalis; Digitalis Glycosides; Drug Therapy; Eye Manifestations; Fatigue; Gastrointestinal Diseases; Geriatrics; Humans; Mental Disorders; Poisoning; Statistics as Topic; Toxicology

Topics: Arrhythmias, Cardiac; Bronchitis; Brugada Syndrome; Cardiac Conduction System Disease; Digitalis; Digoxin; Electrocardiography; Geriatrics; Heart Conduction System; Heart Failure; Humans; Hypertension; Poisoning; Toxicology

Topics: Diagnosis; Digitalis; Digitalis Glycosides; Drug Therapy; Drug-Related Side Effects and Adverse Reactions; Heart Diseases; Poisoning; Toxicology

Topics: Calcium; Calcium, Dietary; Digitalis; Digitalis Glycosides; Drug Therapy; Drug-Related Side Effects and Adverse Reactions; Poisoning; Potassium; Procainamide; Toxicology

Topics: Cardiovascular Agents; Digitalis; Digitalis Glycosides; Poisoning; Suicidal Ideation; Suicide; Toxicology

Topics: Cardiovascular Agents; Digitalis; Digitalis Glycosides; Poisoning; Toxicology

Topics: Cardiovascular Agents; Child; Digitalis; Digitalis Glycosides; Electrocardiography; Poisoning; Toxicology

Topics: Alcoholic Intoxication; Aspirin; Barbiturates; Bromides; Carbon Monoxide Poisoning; Digitalis; Digitalis Glycosides; Glycols; Histamine H1 Antagonists; Intubation; Intubation, Intratracheal; Isoniazid; Kidneys, Artificial; Mercury Poisoning; Poisoning; Statistics as Topic; Toxicology; Tracheotomy; Tranquilizing Agents

Topics: Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Electrocardiography; Emetics; Humans; Infant; Poisoning; Toxicology

Topics: Cardiology; Digitalis; Digitalis Glycosides; Drug Therapy; Heart Diseases; Plant Extracts; Poisoning; Toxicology

Topics: Cardiovascular Agents; Digitalis; Digitalis Glycosides; Electrocardiography; Gastrointestinal Diseases; Humans; Neurologic Manifestations; Poisoning; Toxicology

Topics: Digitalis; Digitalis Glycosides; Drug Therapy; Heart Diseases; Poisoning; Prognosis; Toxicology

Topics: Arrhythmias, Cardiac; Digitalis; Digitalis Glycosides; Humans; Plant Extracts; Poisoning; Potassium

Topics: Arrhythmias, Cardiac; Brugada Syndrome; Cardiac Conduction System Disease; Cardiomyopathies; Digitalis; Digitalis Glycosides; Heart Conduction System; Humans; Poisoning

Topics: Cardiovascular Agents; Child; Digitalis; Infant; Plant Extracts; Poisoning

Topics: Arrhythmias, Cardiac; Cardiovascular Agents; Digitalis; Humans; Poisoning

Topics: Amino Alcohols; Digitalis; Digitalis Glycosides; Guinea Pigs; Heptaminol; Plant Extracts; Poisoning

Topics: Digitalis; Digitalis Glycosides; Heart Failure; Plant Extracts; Poisoning

Topics: Cardiovascular Agents; Digitalis; Drug-Related Side Effects and Adverse Reactions; Humans; Poisoning

Topics: Arrhythmias, Cardiac; Brugada Syndrome; Carbohydrates; Cardiac Conduction System Disease; Digitalis; Digitalis Glycosides; Heart Conduction System; Humans; Poisoning

Topics: Breast Diseases; Digitalis; Edema; Humans; Hypertrophy; Plant Extracts; Plant Leaves; Poisoning

Topics: Digitalis; Hallucinations; Humans; Poisoning; Vision, Ocular

Topics: Cardiac Glycosides; Digitalis; Digitalis Glycosides; Digitoxin; Heart; Plant Extracts; Poisoning

Topics: Adrenal Cortex Hormones; Digitalis; Humans; Plant Extracts; Poisoning; Poisons