Cardiac glycoside toxicity: more than 200 years and counting.

Critical care clinics · Oct 2012

Review

Cardiac glycoside toxicity: more than 200 years and counting.

Digitalis toxicity produces a toxidrome characterized by gastrointestinal, neurologic, electrolyte, and nonspecific cardiac manifestations. Chronic toxicity remains much more difficult to recognize compared with an acute presentation because of the nonspecific manifestations; therefore, serum glycoside levels are essential for diagnosis in this population. The mainstay of management continues to be rapid toxidrome identification followed by digoxin-specific antibody fragment therapy with supportive care. Several controversies still remain, including therapy for patients dependent on hemodialysis, appropriateness of calcium therapy for hyperkalemia, ideal agents for arrhythmia therapy, and the potential utility of plasmapheresis for removal of bound digoxin-antibody fragment complexes.

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- Salmaan Kanji and Robert D MacLean.
- Department of Pharmacy, The Ottawa Health Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. Skanji@toh.on.ca
- Crit Care Clin. 2012 Oct 1;28(4):527-35.
AbstractDigitalis toxicity produces a toxidrome characterized by gastrointestinal, neurologic, electrolyte, and nonspecific cardiac manifestations. Chronic toxicity remains much more difficult to recognize compared with an acute presentation because of the nonspecific manifestations; therefore, serum glycoside levels are essential for diagnosis in this population. The mainstay of management continues to be rapid toxidrome identification followed by digoxin-specific antibody fragment therapy with supportive care. Several controversies still remain, including therapy for patients dependent on hemodialysis, appropriateness of calcium therapy for hyperkalemia, ideal agents for arrhythmia therapy, and the potential utility of plasmapheresis for removal of bound digoxin-antibody fragment complexes.Copyright © 2012 Elsevier Inc. All rights reserved.

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Cardiac glycoside toxicity: more than 200 years and counting.

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