Digoxin Toxicité, Foxglove Poisoning, Yellow-Green Vision Halos, ani Arrhythmie Triage¶

Digoxin (a bɛ feere tɔgɔlafɛnw na i n’a fɔ Lanoxin ani Digitek) ye dusukun gilikosidi ye min bɔra fɔlɔ kɔnɔbara la (Digitalis lanata ani Digitalis purpurea) ani a sɛbɛnnen don walasa ka dusukun tantanni kunbɛn dusukun tantanni na ani ka dusukun tantanni ɲɛ dusukun tantanni basigilen na. Ikomi digosini bɛ ni furakɛli taamasiɲɛ fitininw dɔ ye kɛnɛyaso furakɛli la, dan min bɛ furakɛli joli hakɛ dɔ ni ɲɔgɔn cɛ (0.5 to 0.9 ng/mL dusukun tantanni kama; fo ka se 1.2 ng/mL ka ɲɛsin ɲɛgɛnɛsiralabanaw ma) ani baga hakɛ min bɛ se ka mɔgɔ ka ɲɛnamaya bila farati la, o ka fin i n’a fɔ razɔri. Dusukun glycoside baga minnu bɛ ɲɔgɔn ta walima minnu bɛ ɲɔgɔn cɛ, olu fana bɛ sɔrɔ jiriw la minnu bɛ kɛ ka caya ani laadala furaw la, i n’a fɔ foxglove, oleander commune et yellow (Nerium oleander ani Thevetia peruviana), lily of the valley (Convallaria majalis), red squill, ani Bufo toad venom (a bɛ feere sariya siratigɛ la ko Chan Su walima Love Stone). Ni aw bɛ sigasiga ko mɔgɔ dɔ ye digosini ta kojugu, ka baga basigilen sɔrɔ bana dɔ senfɛ, walima ka dusukun gilikosidi jiri dɔ min, aw bɛ aw ka sigida kɔrɔtɔko nimɔrɔ wele (911 Ameriki ani Kanada, 112 Erɔpu tɔnba bɛɛ kɔnɔ, 999 Angletɛri) an ka kɔrɔtɔko nimɔrɔw ɲɛbilasɛbɛn o yɔrɔnin bɛɛ, ka segin a kan baga furakɛli fɔlɔ, . potasiyɔmu kɔrɔtɔko gɛlɛnw, ani dusukun ni fogonfogon lakununni (CPR) ..

Digosini baga bɛ sɔrɔ kɛnɛyaso cogoya fila la minnu tɛ kelen ye: a tata hakɛ caya kojugu (ka furakisɛ caman walima jiri baga caman munu siɲɛ kelen, o bɛ fɔɔnɔ jugumanba bila mɔgɔ la ani ka mɔgɔ ka ɲɛnamaya bila farati la kalɛmiya caya [joli potasiyɔmu caman sɔrɔli] lɛrɛ damadɔ kɔnɔ) ani toxicité basigilen (a ka ca kosɛbɛ baliku kɔrɔbaw la minnu ka don o don digoxin bɛ caya fo ka se farikolo fagali ma hakɛ minnu bɛ sɔrɔ farikolojidɛsɛ kɔfɛ, sugunɛ joginni jugumanba, sugunɛbilenni min bɛ sɔrɔ hypokalemia [joli potasiyɔmu dɔgɔyali], walima fura kura min sɛbɛnna ka kɛ ɲɔgɔn fɛ i n’a fɔ amiodarone, verapamil, diltiazem, walima clarithromycine). Ni aw ye kɔnɔboli, hakili ɲagami, ani halo jɛman-jɛman (xanthopsia) dɔn, o bɛ a to dɔgɔtɔrɔso jɛkuluw ka Digoxin Immune Fab (Digibind walima DigiFab) di sani bidirectional ventricular tachycardie walima dusukun balili dafalen ka kɛ.

Aw bɛ o kɛ sisan¶

1. Aw bɛ dɔgɔtɔrɔso kɔrɔtɔlenw ni baga kɛlɛbagaw wele joona: Aw bɛ 911 (Amerika ni Kanada), 112 (EU), walima 999 (UK) wele ni digoxin (walima mɔgɔ min ye foxglove, oleander, walima lily of the valley min) ni kɔnɔboli, fɔɔnɔ, dimi, hakili ɲagami, ɲɛnayeli halo walima kulɛri caman cili, dusukun tantanni, walima dɔɔni dɔɔni walima dusukun tantanni min tɛ kɛ cogo la. Ameriki jamana na, aw bɛ kuma Poison Control fana fɛ telefɔni 1-800-222-1222 kan walasa baga dɔnbaga ka se ka Digoxin Immune Fab (DigiFab) sɔrɔli ɲɛnabɔ ni dɔgɔtɔrɔso furakɛlitɔn ye.
2. Aw bɛ digosini tata hakɛ nata bali ka fura buteliw bɛɛ lajɛ: Aw kana a to a tigi ka digosini, sugunɛbilenni furaw (ji furakisɛw i n’a fɔ furosemide walima hydrochlorothiazide), walima dusukun tantanni furaw ta tuguni. Aw bɛ furasɛbɛn buteli bɛɛ lajɛ, fura minnu tɛ sɔrɔ dɔgɔtɔrɔso la, ani jiri tigɛlenw walima kisɛ minnu bɛ o ko la walasa kɔrɔtɔko dɔgɔtɔrɔw ka se ka furaw ni ɲɔgɔn cɛ jɛɲɔgɔnyaw dɔn ani ka furaw tali bɛɛ jate.
3. Aw ye digosini tata hakɛ laban waati tigitigi kɔlɔsi: Ikomi digosini bɛ lɛrɛ 6 fo lɛri 8 ta ka bɔ joli la ka taa dusukun ni kolotugudaw la, digosini joli sɛgɛsɛgɛli serum kɔnɔ min bɛ bɔ lɛri 6 kɔnɔ don o don furakisɛ nɔgɔman na, o bɛna kɛ i n’a fɔ a wulilen don nkalon na ("post-distribution artifact"). Ni aw y’a fɔ triage infirɛri ye furakisɛ laban minna waati tigitigi min na, o bɛ dɔgɔtɔrɔw dɛmɛ ka serum digoxin hakɛ faamuya ka ɲɛ.
4. Aw bɛ a tigi dalen to a da la ani a jɔlen tora pewu: Farikoloɲɛnajɛ bɛ dɔ fara hinɛ katekolamini bɔli kan (epinifirini ni norepinefirini), o bɛ dusukun fasa min doni ka ca ni kalisiyɔmu ye, o lajɔ digosini baga la, wa a bɛ se ka kɛ sababu ye ka kɔnɔbara basigilen faga o yɔrɔnin bɛɛ walima kɔnɔbara basigilen sira fila fɛ. Aw bɛ a tigi to a ka lafiɲɛ fo ka se kɛnɛyabaarakɛlaw ma.
5. Aw kana fɔɔnɔ bila mɔgɔ la: Aw kana a ɲini abada ka banabagatɔ dawolo walima ka fɔɔnɔ kɛ so kɔnɔ. Gagging bɛ vagus nerve lawuli ni fanga ye, ka asetilkolini wulilen bila ka taa atrioventriculaire (AV) node la min bɛ digoxin poisoned kaban, o bɛ se ka dusukun balili dafalen walima sinus jɔli teliya teliya la (asystole).
6. Aw bɛ dɔgɔtɔrɔw ni dɔgɔtɔrɔso baarakɛlaw lasɔmi ni banabagatɔ bɛ digokisini ta sani kalisiyɔmu IV ka di a ma: Ni potasiyɔmu caman bɛ banabagatɔ la joli la (kalisiyɔmu camanba) u ka dɔgɔtɔrɔso joli sɛgɛsɛgɛli fɔlɔ la, aw bɛ aw jija kɔrɔtɔko jɛkulu k’a dɔn joona ko banabagatɔ bɛ digokisini ta walima ko a ye dusukun gilikosidi jiri dɔ min, barisa kalisiyɔmu furakɛli basigilen min bɛ kɛ jolisira fɛ kalisiyɔmu caman sɔrɔli la, o ye laada la ka a yɛrɛ tanga walima ka a bila a nɔ na teliya la Digoxin Immune Fab banakisɛfagalanw furakɛli.

Desizɔn jiri : Digosini ni dusukun gilikosidi sɛgɛsɛgɛli jugumanba ni a basigilen¶

flowchart TD
    Start["Siga bɛ digoxin walima jiriw dusukun na glycoside toxicité (Foxglove, Oleander, Lily of the Valley) ."] --> CallEMS["Aw bɛ telefɔni 911 / 112 / 999 wele ani marabolow ka baga kɔlɔsili; Aw bɛ banabagatɔ lafiɲɛ to a cogo la"]
    CallEMS --> PatternSplit{"Aw bɛ kɛnɛyaso jiracogo jateminɛ"}

    PatternSplit -->|Acute Overdose: Single Large Ingestion of Pills or Toxic Plant| AcutePath["Banakɔtaa jugumanba: Na+/K+-ATPase pɔnpe balili barikama barikama"]
    PatternSplit -->|Chronic Toxicity: Gradual Accumulation on Daily Prescription| ChronicPath["Banakisɛfagalan basigilen: A bɛ sɔrɔ sugunɛbilenni fɛ, farikolojidɛsɛ fɛ, sugunɛbilenni furaw fɛ walima furaw ni ɲɔgɔn cɛ"]

    AcutePath --> AcuteLabs["Fɛn minnu bɛ kɛ ni bana jugumanba ye : Dusukunnata/Fɔɔnɔ joona, HYPERKALEMIA taamasiɲɛ (Serum K+ > 5,0 fo 5,5 mEq/L), Bradycardie/AV Block; Serum Digoxin ka ca kosɛbɛ (Fo ni a kɛra jiri ye min tɛ digoxin ye) ."]
    ChronicPath --> ChronicLabs["Banakisɛ kuntaalajan kunbabaw : Dumunikɛbaliya/Dɔgɔsɔgɔninjɛ donw, Delirium, Yellow-Green Vision Halos (Xanthopsia), A ka ca a la HYPOKALEMIA walima HYPOmagnémie min bɛ bɔ Sugunɛbilenni furaw la; Ventriculaire arrhythmies ni digoxine hakɛ danmadɔ don (> 2,0 ng/mL) ."]

    AcuteLabs --> CheckFab{"Yala banabagatɔ bɛ Digoxin Immune Fab (DigiFab / Digibind) banakisɛfagalan sariyaw dafa wa?"}
    ChronicLabs --> CheckFab

    CheckFab -->|1. Any Life-Threatening Ventricular or Brady-Arrhythmia / Shock| GiveFab["AW KA DIGOXIN IMMUNE FAB NI jolisira fɛ YƆRƆBƆLI"]
    CheckFab -->|2. Acute Overdose with Serum Potassium > 5.0 to 5.5 mEq/L| GiveFab
    CheckFab -->|3. Acute Ingestion > 10 mg (Adult) / > 4 mg (Child) or Steady-State Level > 10-15 ng/mL| GiveFab
    CheckFab -->|4. Symptomatic Chronic Toxicity with Arrhythmia or Hemodynamic Instability| GiveFab

    GiveFab --> PostFabRules["Fab kɔfɛ ICU furakɛli : Serum potasiyɔmu kɔlɔsi kosɛbɛ (A seginni teliya la farikolokisɛw la, o bɛ kɛ sababu ye ka kalɛmiya dɔgɔya); Aw kana segin ka digoxin hakɛ bɛɛ lajɛlen suman joli la (Bound Fab Falsely Elevates Assay) ."]

Banakisɛfagalanw: Dusukun Glycosides bɛ baga don dusukun, kunsɛmɛ ani ɲɛw la cogo min na¶

Digoxin bɛ baara kɛ cogo min na selilɛri ta fan fɛ, o faamuyali bɛ a ɲɛfɔ mun na a bɛ kɛ sababu ye ka joli potasiyɔmu caman (hyperkalemia), slow conduction blocks, hyper-excitable ventriculaire arrhythmies, ani yellow-green vision halos faralen ɲɔgɔn kan:

1. Sodium-Potassium ATPase (Na+/K+-ATPase) Pɔnpe¶

Dusukun farikolokisɛ, nɛrɛmuguma, ani ɲɛda fototalan bɛɛ bɛ u jigi da sodium-potassium ATPase (Na+/K+-ATPase) pɔnpe ka pɔnpe ** soja ion 3 ( .Na+) OUT of the cell** ka sɔrɔ ka pɔnpe 2 potasiyɔmu ion (K+) INTO the cell ka kɛɲɛ n’u ka concentration gradients ye.

Ni digoxin walima jiri dusukun glycoside sirilen don extracellular alpha-subunit of the Na+/K+-ATPase pɔnpe ani k’a bali, cakɛda balawu fila bɛ kɛ waati kelen na:

1. Potassium pile-Up (Potassium pile-Up) min bɛ sɔrɔ selilɛri kɔkan (Hyperkalemia acute):
2. Ikomi kolotugudaw ni dusukunnabanakisɛw tɛ se ka potasiyɔmu ionw don farikolokisɛw la tuguni, potasiyɔmu bɛ to ka siri kɛnɛma joli la.
3. ta hakɛ caya kojugu la, serum hyperkalemia hakɛ ye baromɛtiri kelen ye min bɛ se ka kɛ a hakɛ la Na+/K+-ATPase pɔnpew bɛ baga don farikolo bɛɛ la. Sani Digoxin Immune Fab banakisɛfagalan ka dabɔ, digoxin tata hakɛ jugumanba tabaga minnu ka joli la potasiyɔmu tɛmɛna 5,5 mEq/L (mmol/L) kan, olu kɛmɛsarada la, 100 ɲɔgɔnna de sara, k’a sɔrɔ potasiyɔmu bɛ minnu na ka tɛmɛ 5,0 mEq/L kan, olu ye ɲɛnamaya sɔrɔ.
4. Sodiyɔmu ni kalisiyɔmu caya kojugu selilɛri kɔnɔ (Depolarisations après-dépolarisations et arrhythmies délayées):
5. Ikomi soja tɛ bɔ dusukun na tuguni, sodium intracellular (Na+) bɛ wuli kosɛbɛ.
6. Nin soja camanba in min bɛ selilu kɔnɔ, o bɛ Sodium-Calcium Exchanger (NCX) mago bɛ jiginni na, o min bɛ baara kɛ ni soja kɔnɔna nata ye walasa ka kalisiyɔmu gɛn ka bɔ selilɛri kɔnɔ.
7. O de kosɔn, kalisiyɔmu selilɛri kɔnɔ (Ca2+) bɛ dalajɛ fo ka se baga hakɛ ma dusukun fasa sarcoplasmic reticulum kɔnɔ. Furakɛli hakɛw la, ni kalisiyɔmu min bɛ selilɛri kɔnɔ, o jiginni dɔɔni, o bɛ dusukun tantanni barika bonya dɔɔni dɔɔni (inotropie positif). Toxicité (banakisɛ) la, sarcoplasmic reticulum bɛ doni ka tɛmɛ pewu ni kalisiyɔmu ye, wa a bɛ kalisiyɔmu jikuruw bɔn a yɛrɛ ma ka don sitoplasma kɔnɔ diastole waati.
8. Nin kalisiyɔmu bɔli u yɛrɛma, o bɛ natiriyɔmu jiginni waati kunkurunninw bila kɔnɔna na minnu bɛ Delayed Afterdepolarizations (DADs) bila dusukun walekɛcogo la, ka kɔnɔbara kɔkanna sɔgɔsɔgɔninjɛ bila sen kan ka kɔn a waati ɲɛ, ka dusukun tantanni kuntaalajan paroxysmal, ani ka bidirectional ventricular tachycardie faga.
9. Ton Vagal (Paraasympathique) tɛmɛnen (Block nodal AV):
10. Digoxin bɛ joli siraw barorecepteurs (barorecepteurs arteriales) lawulili kɛ waati kelen na ani ka vagus nerve nuclées cɛmancɛw lawuli, ka sinoatrial (SA) node ani atrioventricular (AV) node fa ni asetilkolini ye.
11. O la, dusukun min baga bɛ digoxin na, o bɛ paradox fagalen dɔ jira: otomatiki damatɛmɛnen ani conduction block jugumanba SA ni AV nodes la (bradycardie ani heart block) o faralen don ɲɔgɔn kan ni dimi jugumanba ni tasuma-fanga yɛrɛma ye atria, His-Purkinje fibres, ani ventricles (ectopic tachyarrhythmias).

2. Mun na potasiyɔmu dɔgɔyali (Hypokalemia) bɛ hali digosini hakɛ nɔgɔmanw kɛ baga ye¶

Iyɔn potasiyɔmu (K+) ni digɔsini mɔlikuluw bɛ ɲɔgɔn sɔrɔ k'u ɲɛsin siriyɔrɔ kelen tigitigi ma kɛnɛma Na+/K+-ATPase pɔnpe: 1 . - Ni banabagatɔ min bɛ digoxin hakɛ bɛnnen ta don o don, o ye lupu walima tiyazidi sugunɛbilennifura daminɛ (i n’a fɔ furosemide [Lasix], bumetanide, torsemide, walima hydrochlorothiazide) walima ni kɔnɔboli/fɔɔnɔ bɛ a la, u joli la potasiyɔmu bɛ dɔgɔya (hypokalemia, K+ < 3.5 mEq/L). - Ni potasiyɔmu ionw dɔgɔyara joli la walasa ka ɲɔgɔn sɔrɔ ni digoxin ye pɔnpe siriyɔrɔ la, digoxin ka ca kosɛbɛ ka siri ani ka a bali Na+/K+-ATPase pɔnpew, o bɛ digosini baga jugumanba lawuli min bɛ se ka a ka ɲɛnamaya bila farati la hali ni banabagatɔ ka digosini hakɛ sumanlen joli la, o bɛ furakɛli hakɛ "normal" kɔnɔ walima a ka ca a la dɔrɔn (1.2 to 2.0 ng/mL). - Magnesiyɔmu dɔgɔyali (manje hakɛ dɔgɔyali, o fana bɛ sɔrɔ sugunɛbilenni fɛ) ani kalisiyɔmu caman sɔrɔli (kalisiyɔmu caman sɔrɔli, o bɛ kalisiyɔmu camanba juguya farikolo kɔnɔ) bɛ digosiniw ka kirinni teliya o cogo kelen na.

Dose tɛmɛnen jugumanba ni Digoxin toxicité chronique: Kɛrɛfɛla ni ɲɔgɔn cɛ¶

Kɔrɔtɔko dɔgɔtɔrɔw bɛ digosini baga kɔrɔtɔ ni kɔrɔtɔ furakɛ cogo wɛrɛ la barisa u ka ɛlektrɔlitiki cogoyaw, u taamasiɲɛw waatibolodacogo, ani u ka digosini hakɛ minnu bɛ joli la, olu bɛ kɛ cogo wɛrɛ la:

Fura minnu bɛ kɛ ɲɔgɔn fɛ tuma caman na ani furakɛli sababu minnu bɛ baga basigilen teliya¶

Dɔgɔtɔrɔso ladonni kɛmɛsarada la 80 ni kɔ digosini baga kosɔn, o bɛ kɛ banabagatɔw la minnu ma furakisɛ wɛrɛ ta abada; o nɔ na, u farikolo ka se ka digosini saniya, o barika banna ni fɛɛrɛ fila dɔ ye:

1. Sugunɛ joginni jugumanba (AKI) ani farikolojidɛsɛ (Blocked Glomerular Filtration):
2. Digosini kɛmɛsarada la 70 fo 80 ɲɔgɔn bɛ bɔ sugunɛ fɛ a ma Changé glomerular filtration ni tubular secretion fɛ.
3. Ni baliku kɔrɔba dɔ ye samiyɛ funteni bana sɔrɔ, kɔnɔboli banakisɛ fɛ (kɔnɔnatumu), sugunɛbilenni/sepsis, walima ni a ye NSAID (ibuprofène, naproxen) walima ACE inhibiteur / ARB daminɛ ka a sɔrɔ a hakɛ dɔgɔyara, u ka glomerular filtration rate (GFR) bɛ dɔgɔya kosɛbɛ ani digoxin bɛ dalajɛ joona joli ni dusukun na farikolo yɔrɔ.
4. P-Glycoprotéine (P-gp) Efflux Pump Inhibitors (Fura ni furaw ka jɛɲɔgɔnya):
5. Banakɔtaa ni sugunɛbara basigilenw kɔnɔ, efflux transporter proteine dɔ min bɛ wele ko P-glycoprotein (P-gp) bɛ digoxin bɔ farikolo la ni timinandiya ye ka don kɔnɔnatumuw ni sugunɛ na.
6. Ni aw ye fura o fura daminɛ min bɛ P-glycoprotein bali o bɛ sugunɛ ni banakɔtaa digoxin bɔli tigɛ ni kɛmɛsarada la 30 ye ka se kɛmɛsarada la 60, o bɛ kɛ sababu ye ka digoxin hakɛ kɛ joli la ka si fila tile kɔnɔ fo ni digoxin hakɛ tigɛra o yɔrɔnin bɛɛ la tilayɔrɔ fila ye:
   • Antiarrhythmics: Amiodarone, dronedarone, quinidine, propafenone, ani flecainide.
   • Calcium Channel Blockers: Verapamil ani diltiazem (olu fana bɛ AV nodal blockade synergique fara digoxin hakɛ jiginni kan, o bɛ dusukun balili dafalen teliya).
   • Makɔrɔlidi banakisɛfagalanw ni ɲɛgɛnɛsiraw: Klaritoromisini, eritoromisini, ani itrakonazɔli (makɔrɔlidi fana bɛ kɔnɔbara basigilenw ban i n’a fɔ Eggerthella lenta minnu bɛ digokisini kɛ banakɔtaa la a ka ca a la).
   • P-gp balilan wɛrɛw: Sikilosporini, takɔrɔlimusi, ranolazini, ritonaviri/nirmatrelvir (Paxlovid), ani karivedilol.

Digoxin Siginidenw dɔnni yecogo, hakiliɲagami ani ECG¶

1. Xanthopsia (The "Van Gogh" Halo Taamaʃyɛn jɛman-Green) ani Neuro-Gastrointestinal Clues¶

Sabula ɲɛkisɛla fototalanw (kɛrɛnkɛrɛnnenya la, kulɛri dɔnni konw) bɛ u ka dibi kuran mara ni fɛn caman ye Na+/K+-ATPase pɔnpew, digoxin balili ɲɛda pɔnpew la, o bɛ yecogo taamasiɲɛw lase mɔgɔ ma minnu tɛ fili, minnu ka teli ka bɔ sanni farikoloɲɛnajɛ jugumanba dɔ ka kɛ: - Chromatopsia ani Xanthopsia: Fɛnw, kogow ani ɲɛda bɛ i n’a fɔ u kolen don ni bulu jɛman, jɛman-jɛman, walima nɛnɛ finman ye, ani yeelen jɛlenw (lanpanw, ɲɛfɛlanw, telewisɔn ɲɛw) bɛ lamini ni korona/halo jɛman-jɛman walima finmanw ye minnu bɛ yeelen bɔ. - Skotomas (Scotomas) minnu bɛ yeelen bɔ ani minnu bɛ yeli kɛ ka ɲɛ: Fiyentɔw yɔrɔ minnu bɛ manamana, yeli minnu bɛ kɛ ni galasi ye, walima sɛbɛnni ɲumanw kalanni gɛlɛya. - Nerological Delirium ("Digoxin Encephalopathy"): Baliku kɔrɔbaw la, digoxin toxicité basigilen bɛ to ka hakiliɲagami jugumanba, jolida, walima hakilibana ladege, a bɛ na ni sugo ɲɛnamaw ye, ɲɛnayeli, ɲɛnayeli jugumanba, hakili ɲagami, jɔrɔ, walima ɲɛda dimi min bɛ i n’a fɔ hakiliɲagami saba saba.

2. Electrocardiogramme classique (ECG) sɔrɔlenw: "Digoxin Effect" ni Digoxin Toxicité lakika¶

Digoxin bɛ se ka dusukun tantanni dɔntaw bɛɛ lase mɔgɔ ma fo ni a ma kɛ ni dusukun tantanni teliya ye (barisa digoxin bɛ AV node sumaya). Dɔgɔtɔrɔw ka kan ka danfara don furakɛli EKG caman yeli ye minnu tɛ kojugu kɛ, ni fɛnɲɛnamafagalanw ye minnu bɛ se ka mɔgɔ ka ɲɛnamaya bila farati la:

• "Digoxin Effect" (Scooped ST Segments / "Salvador Dali Moustache"): A TƐ Toxicité dɔrɔn taamasiɲɛ ye:
• ST-segment depression (jiginni, "scooped" ST-segment depression (min bɛ i n’a fɔ reverse checkmark walima Salvador Dali ka moustache), T waves flattened walima inverted, ani QT interval surun bɛ kɛ banabagatɔ fanba la minnu bɛ furakɛli digoxin ta ka a sababu kɛ ventriculaire repolarisation teliya ye ka bɔ calcium intracellular la. A yɛrɛ la, "digoxin effect" bɛ a jira dɔrɔn ko banabagatɔ bɛ digoxin ta; a tɛ baga jira.
• Digoxine toxicité lakika ka aritmie pathognomonique:
• Kɔnɔbara basigilen caman (PVC) ani kɔnɔbara basigilen : Digoxin toxicité (digoxin toxicité) ka teli ka wuli joona (a bɛ kɛ cogo la min bɛ kɛ ka ɲɛ, o bɛ tugu kɔnɔbara gosi ka kɔn a waati ɲɛ).
• Paroxysmal Atrial Tachycardie (PAT) ni Variable walima 2:1 AV Nodal Block: A bɛ atiriyali otomatiki cayalen fara ɲɔgɔn kan (atrial rate 150 fo 250 bpm) ni AV nodal conduction min bɛ damatɛmɛ ni vagal ye.
• "Regularized" Atrial Fibrillation (AV Block complete with an Accelerated Junctional Escape Rhythm): Banabagatɔ min ka atiriyali fibrillation basigilen bɛ a la, a ka ca a la, a ka pulse irregularly irregular bɛ a la. Ni banabagatɔ min bɛ digoxin ta ka ɲɛgɛnɛsiralabanaw ta, o barika banna ka a tansiyɔn basigilen dafalen sɔrɔ (a bɛ kɛ dɔɔni dɔɔni ni 40 fo 60 bpm ye walima ka teliya ni 65 fo 100 bpm ye), o ye taamasyɛn bilenman ye min b’a jira ko AV bloki degre sabanan dafalen AV ɲɔgɔndan ye a ta yɔrɔ min na i n’a fɔ bolicogo basigilen.
• Bidirectional Ventricular Tachycardie : O ye ritmɛ ye min man teli, a bɛ se ka kɛ banakisɛ ye, wa a bɛ mɔgɔ faga joona, a bɛ se ka ye ko a bɛ ye dusukun glycoside baga jugumanba dɔrɔn de la (ani denbaya ka VT katekolaminɛrɛji polimorfiki), o yɔrɔ la QRS axis bɛ ɲɔgɔn falen-falen bugɔli ni bugɔli la ni degere 180 ye ECG 12-lead kan (a bɛ ɲɔgɔn falen-falen numanbolo ni numan fɛ bundle bolofara bloki cogoya).

Dusukun Glycosides minnu tɛ furakɛli ye: Foxglove, Oleander, Lily of the Valley, ani Toad Venom¶

Balo ɲinibagaw, nakɔbaarakɛlaw, denmisɛnw ani sokɔnɔbaganw ka teli ka dusukun glycoside baga jugumanba sɔrɔ jiriw ni baga nafamaw fɛ minnu bɛ baara kɛ ni digoxin ye min sɛbɛnnen don dɔgɔtɔrɔso la:

Dɔgɔtɔrɔso kisi dafalen : Digoxin Immune Fab (DigiFab / Digibind) ani ICU Protocoles¶

1. Banakisɛfagalan dafalen: Digoxin Immune Fab (Ovine Anti-Digoxin Anticorps Fragments) .¶

Digoxin Immune Fab (a bɛ feere i n’a fɔ DigiFab walima Digibind) bɛ kɛ ni antigène sirili fɛn saniyalenw ye (Fab) minnu bɛ bɔ sagaw la minnu bolocilen don ni digoxin ye. Ni a pikiri kɛra jolisira fɛ miniti 30 kɔnɔ (walima ni a dira i n’a fɔ i teliya la IV bolus push dusukun jɔli walima a binni surunyalen na): - Fab banakisɛfagalanw yɔrɔw ka ɲɔgɔndɛmɛ bɛ digɔsini ni ɲɔgɔn cɛ min fanga ka bon siɲɛ siɲɛ 10 fo siɲɛ 100 ka tɛmɛ digɔsini ka ɲɔgɔndɛmɛ kan hadamaden ta kan Na+/K+-ATPase pɔnpe. - Fab yɔrɔw bɛ digoxin hɔrɔnma siri o yɔrɔnin bɛɛ joli la, ka kɛ sababu ye ka a hakɛ jiginni kɛ min bɛ digoxin molecules sama ka bɔ dusukun ni kolotugudaw la Na+/K+-ATPase pɔnpew, ka pɔnpe baara kɛcogo ɲuman segin a cogo kɔrɔ la miniti 20 fo miniti 60 kɔnɔ ani ka sugunɛ bila ka Fab-digoxin complexe juguman bɔ sugunɛ na.

Digoxin Immune Fab tali teliya la taamasiɲɛ fɔlɔw:¶

Dɔgɔtɔrɔso dɔgɔtɔrɔw bɛ Digoxin Immune Fab di o yɔrɔnin bɛɛ la ni nin sariya ninnu dɔ la kelen dafara: 1. Takyarithmie walima bradyarrhythmie fɛn o fɛn bɛ se ka mɔgɔ ka ɲɛnamaya bila farati la: O ye kɔnɔbara basigilen ye, kɔnɔbara basigilen, VT sira fila fɛ, AV bloki degere filanan walima sabanan min bɛ taa ɲɛ, walima dusukun tantanni taamasiɲɛ minnu tɛ atropine jaabi. 2. Kalemiya camanba (Serum Potassium > 5.0 to 5.5 mEq/L) ni a tata hakɛ caya kojugu: Barisa serum potasiyɔmu sanfɛ 5.0 to 5.5 mEq/L digoxin baga jugumanba la, o bɛ dusukun tantanni min bɛ se ka mɔgɔ faga, o fɔ. 3. Hémodynamique instabilité / Cardiogène shock: Tansiyɔn jiginni walima farikolo yɔrɔ labanw ka joli seginbaliya min bɛ sɔrɔ digosini toxicité fɛ. 4. A dunni jugumanba walima joli la hakɛ dantɛmɛnen (hali sani jolidɛsɛ ka daminɛ): Dumuni juguman dɔnni min ye ka tɛmɛ miligaramu 10 kan baliku la (walima ka tɛmɛ miligaramu 4 kan [walima > miligaramu 0,1/kg] denmisɛnni na), OR digoxin hakɛ min bɛ sɔrɔ joli la a tilatilali kɔfɛ ka tɛmɛ 10 fo 15 ng/mL kan (walima hakɛ o hakɛ ka tɛmɛ 2,0 ng/mL kan banabagatɔ la min ka bana taamasiɲɛw bɛ se ka a ka ɲɛnamaya bila farati la).

Digoxin Immune Fab tata hakɛ (Fiɲɛ kelen kelen bɛɛ = Fab miligaramu 40, o min bɛ Digoxin miligaramu 0,5 siri):¶

• Digoxin hakɛ dɔnni joli la (Kɔrɔlen walima a jɛnsɛnni kɔfɛ): Aw bɛ a caya Serum Digoxin Concentration (ng/mL) ka Patient Weight (kg) ani ka tila tila ni 100 walasa ka jateminɛ kɛ furakisɛw hakɛ la. (Kɔlɔsili: Toxicologie laadilikan caman bɛ a dɛmɛ sisan ka daminɛ ni fiɲɛ 1 fo 2 ye [miligaramu 40 fo 80] baga basigilen basigilen na ani ka segin furakisɛ 1 fo 2 kan miniti 60 kɔnɔ ni a mago bɛ a la, walasa ka dusukun tantanni teliya bali ka teliya yɔrɔnin kelen walima ka dusukun tantanni juguya).
• Furakɛcogo jugumanba min dɔnna (Miligaramu min bɛ munumunu dɔnnen don, a hakɛ bɛ makɔnɔni na): Aw bɛ a caya Total Digoxin Ingested (mg) ka 0.80 (bioavailability) ani ka tila tila ni 0.5 mg bound per vial (walima ka caya mg ingested by 1.6).
• A tata hakɛ min bɛ mɔgɔ ka ɲɛnamaya bila farati la (Dusukun tantanni, a tata hakɛ dɔnbali, walima jiri/nɔnɔw ka Glycoside Poisoning):
• A tata hakɛ caya kojugu / Jiri walima wuluwulu Glycoside Poisoning: Aw bɛ fiɲɛ 10 fo 20 (miligaramu 400 fo 800) IV kɛ a la ka kɛɲɛ ni sɛgɛsɛgɛli ye.
• Digoxin toxicité chronique avec instabilité (Level Still Pending): Aw bɛ fiɲɛ 3 fo 6 (miligaramu 120 fo 240) IV kɛ a la ka kɛɲɛ ni sɛgɛsɛgɛli ye (walima fiɲɛ 1 fo 2 ni dankan sabatira).

2. ICU sariya saba kɔrɔlen ani jan minnu bɛ Digoxin baga la¶

3. Dɛmɛn ka ɲɛsin arrhythmies ni électrolytes ma ka sɔrɔ ka Fab labɛn¶

• Kɔnɔnatumuw bɔli: Aw bɛ Faraba min bɛ kɛ ni a tata hakɛ kelen ye (garamu 1/kg fo garamu 50) ni banabagatɔ nana lɛrɛ 1 fo lɛri 2 kɔnɔ furakisɛ walima jiri juguman dɔ dunni kɔfɛ ani ni a kununna ani ka a fiɲɛbɔyɔrɔw lakana. (Kɔri min bɛ kɛ ni a tata hakɛ caman ye, o fana bɛ se ka digosini ni digitosini ka segin-ka-bɔ sugunɛbaralabana tigɛ ni DigiFab tɛ sɔrɔ).
• Kalemiya dɔgɔyali ni manje dɔgɔyali latilen teliya la baga basigilen na: Ni banabagatɔ min ka digosini toxicité basigilen bɛ a la, potasiyɔmu ka dɔgɔn (< 3.5 to 4.0 mEq/L) walima manje dɔgɔyalen, aw bɛ IV Potassium (min laɲini ye 4,0 fo 4,5 mEq/L ye, ni AV bloki hakɛ caman tɛ a la walima sugunɛbaralabana) ani IV Magnesium Sulfate (garamu 2 miniti 15 fo miniti 20 kɔnɔ) pikiri. Manje ye cofactor ye min bɛ kɛ ka... Na+/K+-ATPase pɔnpe ani ka digoxin-induite ventriculaire ectopie bali hali ni serum magnesium bɛ cogo la.
• Cardie ni AV Block: Aw bɛ Atropine (miligaramu 0,5 fo miligaramu 1 IV) di walasa ka vagal tone tɛmɛnen bali ka a sɔrɔ DigiFab bɛ ka labɛn kokura. Aw bɛ aw yɛrɛ tanga joli-sira-funu-minɛnw ma ni aw bɛ se: ni aw ye senna-tɛgɛrɛ-filɛ siri kinibolo kinibolo la min bɛ digo, min falen don digokisini na ka tɛmɛ a hakɛ kan, o bɛ to ka kɔnɔnatumu fibrillation bila mɔgɔ la min tɛ se ka wuli. Aw bɛ Digoxin Immune Fab kɛ o nɔ na.
• Ventriculaire Tachyarrhythmies: Ka a to DigiFab makɔnɔni na, Lidocaine (1 to 1.5 mg/kg IV) walima Fɛnitoyini (15 mg/kg IV slowly at <= 25 to 50 mg/min) ye antiarrhythmiques ye minnu ka fisa bawo u bɛ afterdepolarizations delayed bali ani tiɲɛ na *ka AV nodal conduction (AV nodal conduction) ɲɛ ka sɔrɔ u ma contractility (contractilité) degun. Aw bɛ aw yɛrɛ tanga procainamide, kinidine, beta-blockers, ani calcium channel blockers (o bɛ AV bloki ni pɔnpe tiɲɛni juguya).
• Aw kana dusukun tantanni kuran fo ni a kɛra Pulseless Arrest la: Ni aw ye kuran sɔgɔli kɛ banabagatɔ la min tɛ digoxin baga ye, ni a ɲɛda bɛ kirin walima ni dusukun tantanni bɛ a ɲɛfɛ, o bɛ to ka dusukun caman tigɛli kɛ kɔnɔnafili min tɛ se ka segin kɔ walima asistole. Ni dusukun tantanni tɛ se ka bali ka ɲɛsin basigibaliya ma min bɛ se ka mɔgɔ ka ɲɛnamaya bila farati la sani DigiFab ka se, aw bɛ ** fanga hakɛ dɔgɔyalenba kɛ (Joules 10 fo 25)** aw kɛlen kɔ ka furakɛli kɛ ka kɔn ni lidokayini ni manje ye.
• Mun na joli-sira-funu tɛ se ka Digoxin jɛya: Sabula digoxin ka hakɛ hakɛ ka bon (5 to 8 L/kg) ni kɛmɛsarada la 90 ni kɔ sirilen don kolotugudaw ni dusukun farikolo yɔrɔw kɔnɔ, joli-diyalizi ni joli-sira-funu TƐ se ka digosini bɔ farikolo la (dialisi bɛ kɛ dɔrɔn ka kalisiyɔmu jugumanba walima ji camanba kunbɛn sugunɛbaralabana na).

Sigidaw ka kɔrɔtɔko nimɔrɔw ani baaradaw ka sariyaw¶

Ɲininkali minnu bɛ kɛ tuma caman na¶

Mun na digosini toxicité bɛ mɔgɔ minnu na, olu bɛ halo jɛman walima jɛman ye yeelenw lamini na (xanthopsia)?¶

Kulɛri dɔnnikɛlan minnu bɛ hadamaden ɲɛda la, olu bɛ u jigi da sodiyɔmu-potasiyɔmu ATPase (Na+/K+-ATPase) pɔnpe kelen tigitigi kan, digɔsini bɛ min bali dusukun fasa la. Ni digoxin (digoxin) bɛ caya farikolo la, a bɛ o pɔnpe ninnu bali ɲɛkisɛ la, o bɛ kɛ sababu ye ka kɔni selilɛriw ka repolarize (repolarize) cogo tiɲɛ yeelen dɔnni kɔfɛ. O bɛ kɛ sababu ye ka yeli kɛ ka ɲɛ, ka yeelen jɛlen dɔn, ani ka hakilijagabɔ kɔrɔlen dɔ wuli min bɛ wele ko xanthopsia, yeelenw bɛ bɔ yɔrɔ min na ka lamini ni halo jɛman, jɛman walima finman ye minnu bɛ manamana ani fɛnw bɛ kɛ ni ɲɛ jɛman ye.

Mun na digosini baga jugumanba sɔrɔla n somɔgɔ la hali ni u ma furakisɛ wɛrɛ ta abada?¶

Digosini kɛmɛsarada la 70 fo 80 ɲɔgɔn bɛ sama ka bɔ farikolo la, sugunɛ tɛ a Changé. Ni baliku kɔrɔba min bɛ u ka don o don digosini furakisɛ ta tuma bɛɛ, farikolojidɛsɛ dɔɔni dɔ bɛ a la ka a sababu kɛ kɔnɔbara basigilen ye, samiyɛ funteni, ji minta dɔgɔyara, walima sugunɛbaralabana, walima ni fura kura dɔ sɛbɛnna a ye i n’a fɔ amiodarone, verapamil, diltiazem, clarithromycine, walima ibuprofène, u sugunɛw bɛ digoxin bɔli dabila o yɔrɔ la hakɛ. Tile damadɔ dɔrɔn kɔnɔ, u ka don o don hakɛ basigilen bɛ caya fo ka se baga hakɛ ma joli ni dusukun fasa la, kɛrɛnkɛrɛnnenya la ni sugunɛbilenni (ji furakisɛ) fana ye potasiyɔmu dɔgɔya u joli la.

Mun na potasiyɔmu caman sɔrɔli (kalisiyɔmu camanba) farati ka bon digosini tali jugumanba la, ka sɔrɔ potasiyɔmu dɔgɔyali joli la (hypokalemia) farati ka bon digosini tali kuntaalajan na?¶

Ni aw ye a tata hakɛ caya kojugu (ka digosini furakisɛ buteli kelen munu siɲɛ kelen), digosini cayalenba bɛ soja ni potasiyɔmu pɔnpe miliyɔn caman datugu farikolo kolotugudaw la waati kelen na, ka potasiyɔmu bali ka don farikolokisɛw la ani ka kɛ sababu ye ka potasiyɔmu caya joli la fo ka se a hakɛ ma min bɛ se ka mɔgɔ faga (kalisiyɔmu caya). O kɔfɛ, mɔgɔ min bɛ digokisini ta don o don kalo caman kɔnɔ, potasiyɔmu ni digosini bɛ ɲɔgɔn sɔrɔ siriyɔrɔ kelen tigitigi la dusukun pɔnpew kan: ni sugunɛbilenni walima kɔnɔboli bɛ potasiyɔmu dɔgɔya joli la (hypokalemia), potasiyɔmu si tɛ to ka digosini bali ka a siri, o bɛ a to hali digosini hakɛ bɛnnen bɛ dusukun bali ka tɛmɛ ani ka mɔgɔ faga kirinni (arrhythmies) minnu bɛ kɛ.

Mun na dɔgɔtɔrɔw bɛ lɛri 6 makɔnɔ don o don digosini furakisɛ tali kɔfɛ sani u ka digosini hakɛ basigilen dɔ ta joli la?¶

Aw kɛlen kɔ ka digosini furakisɛ munumunu, a bɛ don joli la lɛri 1 fo lɛri 2 kɔnɔ, nka a bɛ lɛri 6 fo lɛri 8 kɛ walasa fura ka jɛnsɛn dɔɔni dɔɔni ka bɔ joli la ka siri a laɲinifɛnw na dusukun ni kolotugudaw kɔnɔ. Ni laboratuwari ye joli sama lɛri 2 walima lɛri 3 dɔrɔn don o don furakisɛ ɲuman tali kɔfɛ, joli sɛgɛsɛgɛli bɛna a jira ko "sanni ka tilatila" hakɛ min ka ca ni nkalon ye joli la hali ni dusukun na farikolo yɔrɔw hakɛ bɛ cogo la pewu. Nka, fura tata hakɛ cayalenba kɔrɔtɔlen lakika la, dɔgɔtɔrɔw bɛ laboratuwari basigilenw ja hali bi o yɔrɔnin bɛɛ potasiyɔmu ni EKG kɛrɛfɛ ka sɔrɔ ka sanga 6 tilali finɛtiri to u hakili la.

Yala foxglove, oleander walima lily of the valley dunni ka bɔ nakɔ kɔnɔ, yala dusukun baga bɛ se ka kɛ i n’a fɔ digoxin furakisɛ minnu bɛ sɛbɛn dɔgɔtɔrɔso la wa?¶

Awɔ. Foxglove (Digitalis purpurea), common oleander (Nerium oleander), yellow oleander (Thevetia peruviana), ani lily of the valley (Convallaria majalis) bɛɛ la, dusukun glycosides naturelles bɛ sɔrɔ minnu bɛ baga don dusukun ka sodium-potassium pɔnpe la i n’a fɔ digoxin min bɛ sɔrɔ dɔgɔtɔrɔso la. Ni aw ye furabuluw, falenfɛnw, kisɛw, binkɛnɛ te minnu dilannen don ni balo buluw ye minnu filila ka kɛ komɔri walima kungo alikama ye, walima hali ka ji min ka bɔ falenfɛnw daga kɔnɔ min tun bɛ lili walima oleander jiriw minɛ, o bɛ se ka kɛ sababu ye ka dusukun bali min bɛ se ka mɔgɔ ka ɲɛnamaya bila farati la, kalɛmiya caya, ani ka dusukun tantanni jugumanba bila mɔgɔ la min bɛ se ka kɛ dɔgɔtɔrɔso ladonni gɛlɛn ye ani Digoxin Immune Fab antidote furakɛli.

Gafe minnu bɛ tali kɛ o ko la¶

• Potassium kɔrɔtɔko gɛlɛnw: Dusukun tantanni kalɛmi cayalenba ani dusukun tantanni min bɛ kɛ ni kalɛzi hakɛ dɔgɔyali ye
• Beta-blokɛri ni kalisiyɔmu kanali bloki fura tata hakɛ cayalenba sɛgɛsɛgɛli
• Kungo ɲɛgɛnw balo ɲinini, amatosini, ani jiri bagaji dunni
• Bagabɔ dɛmɛ fɔlɔ ni baga kɛlɛli triage
• Dusukun ni fogonfogon lakununni (CPR) ani AED ɲɛminɛbaga

Sosow ani ɲɛmɔgɔyaso ka bilasiralikan¶

• Ameriki dusukunnakow tɔnba (AHA): San 2023 kunnafoni kura sinsinnen ni laadilikanw dusukun ni fogonfogon lakununni ni dusukun ni jolisiraw ladonni kɔrɔtɔlen kan: Baga jugumanba (Digoxin ni dusukun glycosides) furakɛli.
• Ameriki ka baga kɛlɛli tɔnba (AAPCC) & Ameriki ka dɔgɔtɔrɔso toxicologie kalanso (ACMT): Dɔgɔtɔrɔso baarakɛcogo laadilikanw digosini toxicité acute ni chronique ani digoxin Immune Fab baarakɛcogo sɛgɛsɛgɛli n’a furakɛli kan.
• Jamana ka bagajiw kunnafonidiso (NPIS, Angletɛri): TOXBASE Digoxin, Digitalis ani Cardiac Glycoside Poisoning furakɛli kɛnɛyaso la.
• EXTRIP (Furakɛcogo minnu bɛ kɛ farikolo kɔkan baga la) Baarakɛjɛkulu: Sɛbɛnni seginnkanni ni ladilikanw furakɛli kɔkanna furakɛli kan Digosini baga la.
• Diɲɛ kɛnɛyatɔnba (OMS): Bɔw kunbɛnni ni bagaw ye minnu bɛ sɔrɔ fɛnɲɛnamaw fɛ ani dusukun tantanni jiriw fɛ (Oleander jɛman ni Foxglove).

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Nin gafe in ye kunnafonidi ye, wa a tɛ dɔgɔtɔrɔw ka furakɛli jateminɛ, Poyi Kɔlɔsili ladilikan, walima dɔgɔtɔrɔso ladonni kɔrɔtɔlen nɔ bila. Ikomi dusukun gilikosidi baga bɛ se ka taa ɲɛ joona fo ka se dusukun tantanni walima kɔnɔbara basigilen dafalen ma, an b’a fɔ aw ye kosɛbɛ ko aw ka bololabaarakɛlaw ka dɛmɛ fɔlɔ ni CPR kalan dɔ kɛ min sɛgɛsɛgɛlen don, ka tɛmɛn Croix Rouge ni Croix Rouge ka tɔnba (IFRC) fɛ, aw ka jamana Croix Rouge tɔnba fɛ, St John Ambulance fɛ, walima sigida furakɛlikɛla dɔ fɛ min lakodɔnnen don.