Digitalis toxicity vijay

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Digitalis toxicity vijay

  1. 1. DIGOXIN TOXICITYBy Dr.VIJAYDepartment of Pharmacology
  2. 2. DIGOXIN SOURCE: STRUCTURE: MECHANISM OF ACTION:
  3. 3. DIGOXIN TOXICITYPREDISPOSING FACTORS: Age Hypokalemia Hypercalcemia Impaired renal function Cor pulmonale Cardiac status Hormones Inappropriate useCAUSES :
  4. 4.  Drug interactions causing increase in digoxinlevels: Hypokalemia: Calcium salts: Drugs which displace digoxin fromprotien binding sites: Catecholamines,Sch:
  5. 5. Manifestations of Toxicity CARDIAC TOXICITY:Most common manifestation:PAROXYSMAL ATRIALTACHYCARDIA WITH BLOCKOthers: Multifocal extrasystoles & bigeminyAV blockSinoatrial arrestVT and VF
  6. 6.  GASTROINTESTINAL TOXICITY: NEUROLOGICAL TOXICITY: MISCELLANEOUS TOXICITY:skinrash,eosinophilia,gynecomastia. TOXICITY in Pregnancy:
  7. 7. DIFFERENTIAL DIAGNOSIS CHF and Pulmonary edema Heart Block Beta blocker toxicity VT and VF Low K and high K level Low Mg and high Ca levels.
  8. 8. DIAGNOSIS Symptoms and signs: Past h/o digitalization: ECG: Electrolyte and Renal status: Plasma digoxin level:0.5-2ng/ml:After acute ingestion digoxin level do notnecessarily correlate with toxicity.T1/2 of digoxin is reduced to 10-12hrs afteracute ingestion.
  9. 9.  Plasma digoxin levels should bemeasured at least 6 hours after the lastdose, since this is the time required forattainment of the steady state. An extremely rapid radioimmunoassay for digoxinon the use of iodine 125-labelled digoxin and of a gelequilibration technique for the separation of antibody-bound and free digoxin. Endogenous Digoxin LikeImmunoreactive Substances {DLIS}seen in neonates,renal insufficiency,liverdisease,SAH,CHF,diabetes.
  10. 10. TREATMENT OF TOXICITY Stop digoxin and diuretics: GIT decontamination: Decreasing absorption: Estimate serum potassium: Bradycardia: Mild toxicity:Potassium salts:5-7.5g of KClSerious arrhythmias:40mEq of KCl in 500mlof 5% glucose IV OVER 2-4 hrs.C/I to use of potassium:
  11. 11.  Supraventricular tachyarrhythmias:Propranolol :oral dose of 10-40mg every6hrs /IV .5-1-1mg. Ventricular tachycardia:Lignocaine:1-2mg /kg IV repeat in 20-30mins.Phenytoin: IV:250mg well diluted over 3-5min.
  12. 12.  Severe toxicity:DIGIBINDAntidigoxin antibodies:Source:MOA:Molecular weight:T1/2:Indications:Life threatening arrhythmiasHemodynamic instabilitySevere bradycardiaSerum potassium level:Plasma digoxin level:Time taken for complete response:
  13. 13.  Dosing of Digibind:Vials of digibind=digoxin level[ng/ml]x wt[kg]1001Vial of Digibind=40mg= neutralizes 0.6mg of digoxin.
  14. 14.  Side effects of Digibind:Allergic reactionsExacerbation of CHFHypokalemiaPlasma digoxin level unreliableafter digibind is given.Increased ventricular responseto atrial fibrillation and flutter. CONTRAINDICATIONS:Allergic to sheepprotien, papain, papaya extracts.

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