Hypothermia and changes in an electrocardiogram in an elderly patient

A 81-year-old man was hospitalized with hypothermia. Signs and symptoms of the disease and its complications have been attributed to the living in cold atmosphere, taking too small amounts of food and to the use of diazepam and promazine. On admission to hospital, his rectal temperature reached 28°C. He was unconscious, hypohydrated and bradicardic: 35/min. After therapy was introduced, diuresis was restored and heart frequency reached 64/min, but he was still unconscious. An ECG showed a prolonged corrected QT interval of 0.571 s and monomorphous ventricular premature beats. The aspects of hypothermia and its complications are discussed

atrap in measuring of plasma digoxin level after stopping of a treatment

In this paper, a course of the disease of a 68-year-old patient treated with medigoxin for congestive heart failure is presented. After being withdrawn from his treatment at the hospital, the patient was administered spironolactone and furosemide. The plasma digoxin level at entry was 1.1 nmol/L, after five days it reached 3.2 nmol/L, and after ten days was 2.3 nmol/L. The patient had a normal renal function. The interference of spironolactone and its metabolites with the digoxin radioimmunoassay was discussed as a possible explanation for this phenomena

Electrocardiogram in coma due to intoxication

We analyzed electrocardiogram changes of 20 patients treated because of Intoxication coma at the Department of Internal Medicine. Particular attention was paid to the corrected Q-T interval. The etiology of intoxication coma was the use of anxiolytics, ethanol, pesticides, antidepressants, anti-epileptics, sedatives, hypnotics, trichlorethylene and anti-diabetic chlorpropamide. According to Reed's classification of the depth of coma, nine patients were in degree O-I, seven in degree II-III, and four in degree IV coma. The duration of coma ranged from one hour to six days. Four patients had died, while in 16 the course of the illness was satisfactory. Sinus tachycardia was registered in 11 patients, atrial fibrillation in two, and in seven patients the rhythm was regular. Fifteen of the 20 patients [75%] had had the corrected Q-T interval prolonged with values of up to 0.664 seconds on admission, while in two patients the corrected Q-T interval became prolonged during hospitalization. Malignant dysrhythmia was registered in one patient. The relative risk of a prolonged corrected Q-T in patients with intoxication coma measured 87. The relative risk of malignant ventricular dysrhythmia in a group of coma patients amounted to 30

influence of hemodialysis on concentration of serum digoxin-like substance

Digoxin concentrations in serum samples measured before and after hemodialysis of 31 uremic patients who either never took digoxin or who had not taken digoxin for at least one year. False positive digoxin was found in 22 of 31 patients '[71%] before hemodialysis and in 14 of 31 patients [45%] after hemodialysis. The concentration. ranged from 0.1 to 0.5 nmol/L, mean value was 0.20 +/- 0.16 before hemodialysis and after hemodialysis ranged 0.1 to 0.4 nmol/L, mean value was 0.11 +/- 0.14 nmol/L. The difference before and after hemodialysis is statistically significant. Some of the patients had a constant value before and after hemodialysis, none had a higher value after hemodialysis than they did before. Eight patients, who had positive serum digoxin before hemodialysis with concentrations up to 0.5 nmol/L, became negative after hemodialysis. Our results indicate that a digoxin like substance in uremic serum could be at least partly dialyzable