Abstract
Digitalis poisoning is still frequently encountered in medical practice, either as acute or chronic overdosage. Toxic mechanism is represented by Na+/K+ ATP-ase blockade, followed by an increase in intracellular Na+ and hiperkalemia. Hiperkalemia increases mortality in digitalis poisoning, having a complementary effect to digitalis toxicity. Calcium salts are indicated for cardiac protection in hyperkalemia. Traditionlly, calcium was contraindicated in digitalis poisoning. A careful analisys of available studies demonstrates that calcium salts are useful in treatment of severe hyperkalemia, with electrocardiogram changes, associated with acute digitalis poisoning. Management issues for digitalis poisoning are presented in the end.
Highlights
Digitalis poisoning is still frequently encountered in medical practice, either as acute or chronic overdosage
Datorită folosirii pe scară largă a acestor preparate şi a limitei înguste între nivelul terapeutic şi cel toxic, intoxicaţiile acute cu glicozizi digitalici şi supradozajul cronic rămân o problemă serioasă a practicii medicale actuale
Ranji S.R., Goldman E., Simel D.L., et al Do opiates affect the clinical evaluation of patients with acute abdominal pain? JAMA. 2006; 296:1764-1774
Summary
– tipul Cardenolide: Strophanthus – ouabaină g/k/e-strofantină; Digitalis lanata şi Digitalis purpurea (degeţel) – digoxin, digitoxin; Nerium oleander (leandru) –. Calciul antagonizează efectele celulare ale hiperkaliemiei prin mai multe mecanisme: protejează miocardul prin antagonizarea efectelor toxice ale hiperkaliemiei asupra membranei celulare, reducând riscul TV fără puls sau FiV; creşte pragul depolarizării şi poate reduce excitabilitatea care apare în hiperkaliemia moderată (prin legarea de gura canalelor de sodiu, crescând potenţialul transmembranar de repaus „efectiv“ ce controlează aceste canale, făcându-le greu de activat); îmbunătăţeşte conducerea în sistemul Purkinje şi restaurează activitatea de pacemaker a celulelor specializate sinusale şi din nodul AV, favorizând propagarea impulsurilor [7,12,13]. Hipercalcemia poate potenţa toxicitatea digitalică, astfel că la pacienţii digitalizaţi sau suspecţi a avea niveluri toxice de glicozizi digitalici, calciul este recomandat doar dacă sunt absente undele P sau apare un complex QRS larg, cu aspect sinusoidal.
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