digoxin and Multiple-Organ-Failure

Topics: Adult; Amino Acids; Cardiac Output; Cardiovascular System; Cells; Digoxin; Energy Intake; Energy Metabolism; Female; Heart Diseases; Humans; Infections; Intubation; Metabolic Diseases; Multiple Organ Failure; Myocardium; Positive-Pressure Respiration; Probability; Respiratory Insufficiency; Vascular Resistance

Topics: Alprazolam; Antidotes; Digoxin; Diltiazem; Extracorporeal Membrane Oxygenation; Fat Emulsions, Intravenous; Fatal Outcome; Female; Hemofiltration; Humans; Middle Aged; Multiple Organ Failure; Poisoning

Thyroid storm is a life-threatening condition that is generally considered to be a contradiction to surgical intervention. We herein describe the case of a 37-year-old patient with a history of Graves' disease who was transferred to Tottori University Hospital with thyroid storm. She had been followed by her family doctor since 2006, but she had stopped taking her medication of her own volition in 2010. About ten days prior to her admission at our hospital, she consulted her family doctor with complaints of dyspnea, palpitations and general fatigue. Subsequent thyroid function tests showed TSH < 0.01 μU/ml, FT3 25.0 pg/ml and FT4 8.0 ng/dl. She also had acute heart failure, atrial fibrillation and hepatic failure. A diagnosis of thyroid storm was made and she was transferred to our hospital. She received steroids, beta blockade, potassium iodide, and plasma exchange, but her hepatic failure did not resolve and her clinical condition deteriorated. The decision was made to proceed with thyroidectomy. Postoperatively, her hepatic function normalized. Thus, thyroidectomy is a potential therapeutic choice for cases of thyroid storm refractory to medical management.

Topics: Adult; Antithyroid Agents; Betamethasone; Combined Modality Therapy; Contraindications; Digoxin; Diuretics; Female; Graves Disease; Humans; Multiple Organ Failure; Potassium Iodide; Thyroid Crisis; Thyroidectomy; Treatment Outcome

Canrenone and spironolactone caused falsely low readings in a common assay for digoxin (AxSym MEIA) due to negative cross-reactivity. Misleading subtarget concentrations were repeatedly reported, and falsely guided drug dosing resulted in a case of digoxin intoxication.

Topics: Aged; Canrenone; Digoxin; Drug Interactions; Drug Monitoring; Enzyme Multiplied Immunoassay Technique; Fatal Outcome; Humans; Male; Medication Errors; Multiple Organ Failure; Sepsis; Spironolactone

The hemodynamic response after an iv loading dose of amiodarone for resistant supraventricular tachyarrhythmias was studied in ten critically ill patients receiving a catecholamine infusion for shock. A loading dose of amiodarone, 3.7 to 5.0 mg/kg, was infused over 2 h while the catecholamine infusion dose requirements were monitored. There was a significant decrease in heart rate (mean 16%, p less than .01), and an increase in stroke volume index (mean 29%, p less than .01) and left ventricular stroke work index (mean 34%, p less than .01). Cardiac index, oxygen availability index, and mean arterial pressure were not changed significantly. The reported adrenoreceptor antagonism of amiodarone did not change catecholamine dose requirements in this study. In nine of ten patients, sinus rhythm was achieved and maintained. The loading dose of amiodarone had no significant acute effect on plasma digoxin concentrations. Despite good arrhythmia control, mortality was high.

Topics: Aged; Aged, 80 and over; Amiodarone; Cardiac Output; Catecholamines; Digoxin; Drug Synergism; Heart Rate; Hemodynamics; Humans; Middle Aged; Multiple Organ Failure; Stroke Volume; Tachycardia, Supraventricular