Management of digoxin poisoning

2016 ◽  
Author(s):  
Frédéric Lapostolle ◽  
Stephen W. Borron
Keyword(s):  
The Elderly ◽  
Clinical Findings ◽  
Digitalis Toxicity ◽  
Fab Fragments ◽  
Digitalis Poisoning ◽  
Digitalis Glycoside ◽  
The Face ◽  
The Usa ◽  
Life Threatening ◽  
Digoxin Poisoning

Despite a gradual decline in the clinical use of digitalis glycosides, digitalis toxicity continues to be responsible for substantial morbidity and mortality, particularly among the elderly. Digitalis poisoning may occur acutely, after intentional overdose, but is more often seen as the result of chronic intoxication among patients receiving digitalis therapy. Clinical findings in chronic digitalis poisoning are often subtle. The astute clinician will enquire about digitalis use in older patients with vague complaints and will not be dissuaded from considering digitalis toxicity in the face of a ‘therapeutic’ digitalis blood concentration. Two digitalis preparations continue to be used with frequency, depending on geography. Digoxin is the digitalis glycoside of choice in the USA, while digitoxin prevails in some parts of Europe. While the methods and half-lives of elimination differ markedly for these two substances, the approach to poisoning by either is similar. Advanced age, underlying cardiovascular disease, and severe hyperkalaemia represent poor prognostic factors in digitalis poisoning. Early administration of digitalis Fab fragments should be undertaken when life-threatening symptoms are present. Prophylactic therapy with reduced doses of Fab fragments should be strongly considered for less serious toxicity.

Fab Fragments in Treatment of Digoxin Ingestion

PEDIATRICS ◽  
1983 ◽  
Vol 71 (1) ◽  
pp. 137-137
Author(s):  
THOMAS W. SMITH
Keyword(s):  
Multicenter Trial ◽  
Clinical Safety ◽  
Digitalis Toxicity ◽  
Safety And Efficacy ◽  
Fab Fragments ◽  
Life Threatening ◽  
September Issue

To the Editor.— Accompanying the paper of Zucker et al in the September issue of Pediatrics1 is a listing of sources from which digoxin-specific Fab fragments are stated to be available. Unfortunately, this is no longer the case. All of the individuals and institutions listed have been part of a multicenter trial of clinical safety and efficacy of purified digoxin-specific Fab fragments in the treatment of advanced, life-threatening digitalis toxicity. At the present time, however, supplies of the material are extremely limited, and several of the centers listed have exhausted their supplies of digoxin-specific Fab fragments.

Fab Fragments of Digoxin-Specific Antibodies Used to Reverse Ventricular Fibrillation Induced by Digoxin Ingestion in a Child

PEDIATRICS ◽  
1982 ◽  
Vol 70 (3) ◽  
pp. 468-471
Author(s):  
Aaron R. Zucker ◽  
Samuel J. Lacina ◽  
D. S. DasGupta ◽  
H. A. Fozzard ◽  
David Mehlman ◽  
...  
Keyword(s):  
Ventricular Fibrillation ◽  
Digoxin Level ◽  
Bundle Branch Block ◽  
Specific Antibodies ◽  
Fab Fragments ◽  
Intellectual Function ◽  
Digitalis Poisoning ◽  
Life Saving ◽  
Life Threatening ◽  
Massive Overdose

Digitalis poisoning is a rare problem in children, but it may be life threatening. A case of massive overdose of digoxin in a 2½-year-old boy that produced prolonged ventricular fibrillation refractory to conventional therapy is reported. After two hours the boy was given digoxin-specific Fab fragments of antibody in sufficient quantity to bind his estimated dose of 10 mg. By completion of the treatment minutes later, normal rhythm and circulation were restored. The serum free digoxin level before antibody administration was > 100 ng/ml, and it rapidly fell to undetectable levels after antibody was given. Digoxin bound to the antibody had a clearance half-life of approximately 48 hours. The child had no apparent neurologic damage and his intellectual function was normal on discharge. He had a transient hematuria and a residual incomplete right bundle branch block. Administration of purified Fab fragments of digoxin-specific antibodies can be life saving in children with digitalis poisoning, and prolonged cardiopulmonary resuscitation in children is justified when the cause of cardiac arrest is potentially reversible.

scholarly journals On the importance of early testing even when imperfect in a pandemic such as COVID-19

2020 ◽  
Author(s):  
Neal D. Goldstein ◽  
Igor Burstyn
Keyword(s):  
False Negative ◽  
Clinical Findings ◽  
Laboratory Findings ◽  
Predictive Values ◽  
Clinical Observations ◽  
The Face ◽  
The Usa ◽  
Early Testing ◽  
The Difference ◽  
Sensitivity Specificity

Diagnosis of COVID-19 may be based on clinical observations, laboratory findings, and epidemiological linkage.1 Underscoring this diagnosis is accurate data from laboratory tests: this can make the difference between a false positive based on the clinical findings that are attributable to another cause, or a false negative based on lack of clinical findings that are attributable to SARS-CoV-2 viral infection, the causal agent for COVID-19. We conducted a simulation depicting how predictive values vary in the face of unknown data surrounding test sensitivity, specificity, and reported cases. in the USA. There are two main implications of our findings. First, the prevalence of COVID-19 in the tested population is likely inflated: clinical disease attributable to other sources of infection such as influenza, or other respiratory viruses, is a plausible explanation. Second, we should be less alarmed by not being able to trace chain of transmission for many who test positive early in this pandemic when population prevalence is low.

scholarly journals Multimorbidity, Drug Combinations, Spike Epitopes and Fast Testing as Central Factors in COVID-19 Treatments

2020 ◽  
pp. 1-5
Keyword(s):  
Coronary Artery Disease ◽  
Nervous System ◽  
Distress Syndrome ◽  
The Elderly ◽  
Respiratory Complications ◽  
Donald Trump ◽  
The Usa ◽  
Life Threatening ◽  
Artery Disease ◽  
Central Factors

Since December 2019 almost 20 million infected and 1000,000 deaths. Today we hear the at the USA president Mr. Donald Trump (age 74) has contracted the corona disease. The Hard acute breathing Distress Syndrome (SARS-CoV-2) has been reported worldwide. Even though Coronary artery disease (COVID-19) Respiratory complications Were the most common and life-threatening, there Frequent reports of central and peripheral nervous system (PNS) involvement. It was thought that the elderly are more vulnerable to the disease, which turns out as wrong.

scholarly journals Serotonin Syndrome Complicating Treatment of Ifosfamide Neurotoxicity With Methylene Blue

2017 ◽  
Vol 24 (5) ◽  
pp. 107327481772907 ◽  
Author(s):  
Matthew Snyder ◽  
Suhas Gangadhara ◽  
Andrew S. Brohl ◽  
Steven Ludlow ◽  
Sowmya Nanjappa
Keyword(s):  
Methylene Blue ◽  
Serotonin Syndrome ◽  
Clinical Findings ◽  
Vulnerable Population ◽  
Neurological Recovery ◽  
The Face ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Clinical Stabilization

Methylene blue is a widely used treatment for ifosfamide neurotoxicity. We present a case of severe encephalopathy complicating ifosfamide-based therapy for recurrent retroperitoneal leiomyosarcoma. After treatment with methylene blue, the patient experienced clinical decompensation and was diagnosed with serotonin syndrome based on a constellation of clinical findings. Withdrawal of methylene blue and other serotonergic medications led to clinical stabilization and ultimately neurological recovery. Our case highlights the challenge of diagnosing serotonin syndrome in the face of preexisting ifosfamide neurotoxicity, as there is significant clinical overlap between these 2 syndromes. Practitioners must remain vigilant of this potential life-threatening complication in this vulnerable population.

An Immigrant Filmmaker Substitutes an Alternative Vision of Adolescence: The Scarecrow (Sam Pillsbury, 1982)

2018 ◽  
Author(s):  
Alistair Fox
Keyword(s):  
New Zealand ◽  
Cinematic Adaptation ◽  
Alternative Vision ◽  
The Face ◽  
The Usa ◽  
Genre Film

By comparing Sam Pillsbury’s cinematic adaptation of Ronald Hugh Morrieson’s The Scarecrow (1963) with the original, this chapter shows how the filmmaker, who was raised in the USA and immigrated to New Zealand in his teens, empties the source novel of the moral ambiguities and transgressive elements that had made the original a genuinely New Zealand work, in so far as it reflected puritan guilt over transgressive impulses in the face of repression, and thus turned the story into a genre film that that is much more anodyne in its vision.

Infections caused by medical products at longterm nursing care

2020 ◽  
pp. 7-10
Author(s):  
Hardy Thorsten Panknin
Keyword(s):  
Nursing Care ◽  
Nursing Staff ◽  
Nosocomial Infections ◽  
The Elderly ◽  
Relevant Information ◽  
Medical Products ◽  
The Disabled ◽  
The Usa ◽  
Therapeutic Measures

Nosocomial infections in the elderly, often suffering from many ailments, patients in homes for the disabled and the old are among the problematic diseases that specialized nursing staff and doctors have to deal with more often in such institutions. Review work from the USA introduces relevant information about infectious risks, as well as possible preventive and therapeutic measures.

Q fever: a rare but potentially life-threatening zoonotic disease

2021 ◽  
Vol 14 (2) ◽  
pp. e237155
Author(s):  
Pranav Mahajan ◽  
Kailash Pant ◽  
Shirin Majdizadeh
Keyword(s):  
Chronic Disease ◽  
Cardiovascular System ◽  
Q Fever ◽  
Acute Infection ◽  
Acute Illness ◽  
Unknown Aetiology ◽  
Severe Hepatitis ◽  
The Usa ◽  
Life Threatening ◽  
Acute Q Fever

Q fever can present as a fever of unknown aetiology and can be challenging to diagnose because of the rare incidence. It can present as an acute illness with manifestations, including influenza-like symptoms, hepatitis, pneumonia or chronic disease involving the cardiovascular system. We present a case of a 39-year-old woman in the USA, who developed acute Q fever with associated sepsis and severe hepatitis. She received treatment with recovery from acute infection but currently has symptoms of post Q fever syndrome.

An Environmental Justice Analysis of British Air Quality

2003 ◽  
Vol 35 (5) ◽  
pp. 909-929 ◽  
Author(s):  
Gordon Mitchell ◽  
Danny Dorling
Keyword(s):  
Air Pollution ◽  
Air Quality ◽  
Environmental Justice ◽  
The Elderly ◽  
Local Communities ◽  
Car Ownership ◽  
National Study ◽  
Environmental Injustice ◽  
The Usa ◽  
History Of

This paper presents the results of the first national study of air quality in Britain to consider the implications of its distribution across over ten thousand local communities in terms of potential environmental injustice. We consider the recent history of the environmental justice debate in Britain, Europe, and the USA and, in the light of this, estimate how one aspect of air pollution, nitrogen dioxide (NO2) levels, affects different population groups differentially across Britain. We also estimate the extent to which people living in each community in Britain contribute towards this pollution, with the aid of information on the characteristics of the vehicles they own. We find that, although community NO x emission and ambient NO2 concentration are strongly related, the communities that have access to fewest cars tend to suffer from the highest levels of air pollution, whereas those in which car ownership is greatest enjoy the cleanest air. Pollution is most concentrated in areas where young children and their parents are more likely to live and least concentrated in areas to which the elderly tend to migrate. Those communities that are most polluted and which also emit the least pollution tend to be amongst the poorest in Britain. There is therefore evidence of environmental injustice in the distribution and production of poor air quality in Britain. However, the spatial distribution of those who produce and receive most of that pollution have to be considered simultaneously to see this injustice clearly.

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