ABSTRACT
Digitalis glycosides are among the oldest drugs used in cardiology. Nowadays, due to the limited indications for their use (advanced heart failure, usually concomitant with atrial fibrillation), cases of poisoning induced by this class of drugs are rarely observed. Digoxin produces a positive inotropic and bathmotropic effect on the heart, but has a negative chronotropic and dromotropic effect. Cardiac glycosides have a narrow therapeutic window, so digitalis treatment can easily lead to symptoms of overdose. In patients taking digoxin, the drug therapeutic level should be maintained at 1-2 ng/ml; the toxic effects occur at concentrations > 2.8 ng/ml and are mainly related to disturbances of cardiac function and of the circulatory system, as well as gastrointestinal symptoms and CNS disturbances. We present, a 45-years-old patient who was hospitalized following the ingestion with suicidal intent of 100 0.25 mg tablets of digoxin. In spite of rapidly applied gastric irrigation and administration of activated charcoal, the drug level in the patient's blood was estimated at 12.0 ng/ml. During her stay on the ward, typical symptoms of severe poisoning were observed: from gastric symptoms (severe nausea, vomiting) to numerous severe arrhythmias and conduction disturbances. Type I, II and III AV blocks were detected, as well as numerous ventricular and supraventricular extrasystoles. These conduction disorders required the use of temporary endocardial pacing. Due to the unavailability of specific antidotes (antidigitalis antibodies) and lack of efficient methods of extracorporeal elimination of the drug, symptomatic treatment comprising the correction of electrolyte disturbances and heart rate control remains the most effective.
Subject(s)
Arrhythmias, Cardiac/chemically induced , Digoxin/poisoning , Water-Electrolyte Imbalance/chemically induced , Water-Electrolyte Imbalance/therapy , Arrhythmias, Cardiac/diagnosis , Atrial Fibrillation/chemically induced , Atrial Fibrillation/diagnosis , Digoxin/blood , Electrocardiography , Female , Fluid Therapy , Humans , Middle Aged , Nausea/chemically induced , Suicide, Attempted , Vomiting/chemically inducedABSTRACT
All inflammatory processes or damaging factors affecting human organism increase the levels of pro-inflammatory proteins, i.e. acute phase proteins, in the serum in a statistically significant way. Among these proteins, interleukin-6 and C-reactive protein (CRP) are of the highest prognostic value for the process dynamics. The aim of the present study was to evaluate feasibility of determining the level of the CRP as a diagnostic and prognostic marker in acute poisonings. Out of a group of 132 patients hospitalised in the Lublin Toxicological Centre, 67 patients observed were poisoned with the CNS acting agents, 17 patients were intoxicated with alcohol, 10 patients overdosed cardio-vascular drugs and 6 were exposed to carbon monoxide. In the above mentioned groups, alcohol and CNS acting agents increased CRP values in over 33% of the patients, whereas in the case of patients under the influence of cardiac drugs or carbon monoxide, the same effect was observed in more than 16% of the cases. Moreover, an attempt to evaluate the dynamics of the CRP level changes in time was undertaken; a concentration increase was observed in 65% of the patients during the second day of hospitalisation. Our results suggest that the determination of the C-reactive protein levels can be a cheap prognostic test evaluating severity of acute poisoning cases.
Subject(s)
C-Reactive Protein/metabolism , Inflammation/chemically induced , Poisoning/blood , Poisoning/diagnosis , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Diagnosis, Differential , Female , Humans , Inflammation/blood , Interleukin-6/metabolism , Male , Middle Aged , Predictive Value of Tests , Prognosis , Sensitivity and Specificity , Severity of Illness IndexABSTRACT
A retrospective analysis of cases of acute poisoning with cardiovascular drugs in the period from 1999 to 2002 has been carried out. A total of 72 poisoned patients was treated in the study period in the Lublin Regional Toxicological Centre. The poisoned were mostly women (69%), out of whom 76% were under 30. More than 66% were the cases of mixed poisoning, especially with antidepressant or sedative-hypnotic drugs. Alcohol poisoning was diagnosed in 28% of cases and it was statistically more frequent in men than in women (54.6% and 16.0%, respectively). Cardiovascular drugs were the most frequent cause of suicidal poisoning cases, i.e. beta-blockers were the cause of 40% poisoning cases, ACEI inhibitors--22%, and calcium channel blockers--19%. In 25 cases (in 18 women and 7 men) severe poisoning caused bradyarrhythmia or hypotonia which resulted in the death of 2 patients.
