Digoxin case .ppt

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Case Presentation

Dr.Yassin

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History

• 2 years old healthy boy.• Presented with Hx of ingestion of

digoxin tablets . 15 min prior to ER visit.

• Amount is unknown.• Digioxin 62.5 mic .



History

• No Hx of abnormal movement.• No Hx of vomiting.• No Hx of palpitation.



History

• Perinatal Hx:• Past medical and surgical Hx:• Allergy:• Vaccination Hx:• Family Hx:• Social Hx:• Developmental Hx:

UNREMARKABLE



EXAM• Looks well.• HR: 123• RR: 24• B/P: 109\47• Temp: 36.5

• CVS: WNL• RS: WNL• CNS: WNL• ABDOMIN: WNL



ER course

• Patient taken immediately to ER.• Gastric lavage done revealed tablet

particles.• Charcol given.



impression

Digoxin ingestion



PLAN OF

CARE

investigation treatment education



investigation



investigation





investigation



investigation



Digoxin Toxication



digoxin• Antiarrhythmic agent, inotrope.• Cardiac Glycoside.

• T1/2: Premature infants, 61–170 hr.• full-term neonates, 35–45 hr.• infants, 18–25 hr.• children, 35 hr.

• Indication: heart failure, Supraventricular tachycardia .



Presentation of toxication

• CVS: asystole, atrial or nodal ectopic beats. • A-V block, AV dissociation, S-A block,

ventricular arrhythmias, • first-, second- (Wenckebach), or third-degree

heart block.• CNS: Seizure.lethargy, headache, visual

disturbance. • electrolyte imbalances Hyperkalemia • GIT: diarrhea, nausea, vomiting



Risk factor

• Impaired renal function.• Hypokalemia.• Hypomagnesemia.• Hypercalcemia. • low thyroxine.



Monitoring

• Digoxin levels are most useful if measured 4–6 hr after ingestion.

• Therapeutic serum digoxin concentration: <2ng/mL

• Toxic serum digoxin concentration: >4ng/mL



Monitoring

• 12-lead ECG and continuous cardiac monitoring.

• Monitor electrolytes (calcium, magnesium, potassium) hourly.



management

• Supportive Care/Decontamination: • CAB• Activated charcoal up to several hours

postingestion.



Specific treatment• Antidote: Digoxin Specific Antibody

Fragments (Fab)

• Indications: • severe toxicity (ventricular, progressive

bradyarrhythmias, 2nd or 3rd degree heart block).

• serum potassium >5 mEq/L .• serum digoxin concent >4-10 ng/mL ????



Specific treatment

• Serum digoxin concentration increases after Fab secondary to intravascular diffusion of antibody-bound, inactive digoxin.

• Adverse reactions: Allergic reaction, rebound hypokalemia, CHF (secondary to the sudden decrease in digoxin's inotropic effect).



Treatment cont• Electrolyte disturbances (hyperkalemia):• typically self-correct after Fab treatment.

• Bradyarrhythmias: Fab is first-line therapy; consider atropine, dopamine, epinephrine, or isoproterenol for second-line therapy.

• Asystole and pulseless electrical activity (PEA) Life-threatening tachyarrhythmias Treat according to Pediatric Advanced Life Support (PALS) protocol.



THANK YOU



Management calculating the dose

• First, determine total body digoxin load (TBL):• TBL (mg) = serum digoxin level (ng/mL) × 5.6 ×

wt (kg) ÷ 1000,• OR TBL (mg) = mg digoxin ingested × 0.8• Then, calculate digoxin immune Fab dose:• Dose in number of digoxin immune Fab vials

(Digibind or DigiFab): vials = TBL ÷ 0.5• Infuse IV over 15–30 min


Digoxin case .ppt

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