Toxicité ya Digoxine, Empoisonnement na gant de Fox, Halos ya Vision Jaune-Verte, mpe Triage ya Arrhythmie¶

Digoxine (etekamaka na ba kombo ya marque lokola Lanoxin na Digitek) ezali glycoside cardiaque oyo ewutaka na ebandeli na nzete ya gant fox (Digitalis lanata mpe Digitalis purpurea) mpe epesami mpo na kopekisa rythme cardiaque ventriculaire na fibrillation auriculaire mpe mpo na kobongisa contractilité myocardique na insuffisance cardiaque chronique. Lokola digoxine ezali na moko ya ba indices thérapeutiques ya mike koleka na médecine clinique, ndelo kati na niveau ya makila ya traitement (0.5 to 0.9 ng/mL mpo na maladi ya motema; kino na 1.2 ng/mL mpo na fibrillation auriculaire) mpe nivo ya ngɛngɛ oyo ekoki koboma moto ezali moke lokola rasoir. Ba poisons glycosides cardiaques identiques to réactifs croisées ezwamaka pe na ba plantes ornementales oyo emonanaka mingi pe na ba kisi ya bonkoko, na kati na yango gant de renard, oléander commune et jaune (Nerium oleander et Thevetia peruviana), lis du vallé (Convallaria majalis), squill rouge, na Venom ya toad Bufo (etekamaka na ndenge ya mabe lokola Chan Su to Libanga ya Bolingo). Soki ozali kokanisa ete moto ameli digoxine mingi, azwi toxicité chronique na tango ya bokono, to ameli molona ya glycoside ya motema, benga nimero ya urgence ya esika ofandi (911 na Etats-Unis mpe Canada, 112 na Union européenne mobimba, 999 na Royaume-Uni) na nzela ya biso banimero ya mbalakaka répertoire mbala moko, mpe kotalela lisusu kopesa ngɛngɛ lisalisi ya liboso, . ba urgences critiques ya potassium, mpe kozongisama ya motema mpe ya mimpululu (CPR) ..

Empoisonnement ya digoxine emonanaka na ba modèles cliniques mibale ekeseni : overdose aiguë (komela ba pilili ebele to ba plantes toxiques na mbala moko, oyo esalaka que esanza makasi mpe ezongisaka bomoi na likama hypercalémie [potassium mingi na makila] na kati ya bangonga) mpe toxicité chronique (emonanaka mingi na ba grands adultes oyo digoxine na bango ya mokolo na mokolo etongaka tii na ba tissus lethiques nivo nsima ya kozanga mai na nzoto, kozoka makasi na rein, hypocalémie [potassium moke na makila] oyo euti na diurétique, to nkisi ya sika oyo bakomeli yango oyo esalaka na boyokani lokola amiodarone, verapamil, diltiazem, to clarithromycine). Koyeba nausea ya liboso, mobulungano, mpe halos visuels jaune-vert (xanthopsie) epesaka nzela na ba équipes ya lopitalo kopesa Digoxin Immune Fab (Digibind to DigiFab) yambo ya tachycardie ventriculaire bidirectionnelle oyo ebomaka to blocage cardiaque mobimba esalema.

Sala boye sikoyo¶

1. Benga ba services médicaux ya urgence mpe contrôle ya poison mbala moko: Benga na 911 (Etats-Unis mpe Canada), 112 (UE), to 999 (Royaume-Uni) soki moto oyo azali komela digoxine (to moto oyo ameli gant fox, oleander, to lis ya lobwaku) azwi nausea, kosanza, kizunguzungu, mobulungano, ba halos ya komona to mbongwana ya langi, kobɛtabɛta motema, to kosala malembe to pulse oyo ezali mbala na mbala te. Na Etats-Unis, benga pe Poison Control na 1-800-222-1222 po toxicologue akoki ko coordonner disponibilité ya Digoxin Immune Fab (DigiFab) na pharmacie ya lopitalo.
2. Kokanga dose oyo elandi ya digoxine mpe kosangisa milangi nyonso ya nkisi: Kotika te moto amela lisusu digoxine, ba diurétiques (ba pilili ya mayi lokola furosemide to hydrochlorothiazide), to ba kisi ya rythme cardiaque. Sangisa molangi nyonso oyo monganga akomeli yo, supplément oyo ekoki kosombama na monganga te, mpe biteni nyonso ya banzete to mboto oyo etali yango mpo ete minganga ya nokinoki bakoka koyeba boyokani ya nkisi mpe kosala calcul ya exposition totale.
3. Tala ngonga ya montre ya sikisiki ya dose ya suka ya digoxine: Lokola digoxine ezuaka heures 6 à 8 mpo na kokabolama uta na makila na ba tissus ya motema mpe ya misisa ya mikuwa, test ya makila ya digoxine ya sérum oyo esalemi na kati ya ngonga 6 ya pilili ya mokolo na mokolo normal ekozala komonana lokuta elevé ("artifact post-distribution"). Koyebisa infirmier ya triage ngonga ya sikisiki oyo bamelaki pilili ya nsuka esalisaka minganga bálimbola malamu nivo ya digoxine na sérum.
4. Kobatela moto alali mpe kimia mpenza: Kosala makasi na nzoto ebakisaka kobimisama ya catecholamine sympathique (épinephrine mpe norépinephrine), oyo e sensibiliser misisa ya motema oyo ezali na calcium mingi na toxicité ya digoxine mpe ekoki mbala moko ko déclencher fibrillation ventriculaire fatale to tachycardie ventriculaire bidirectionnelle. Bomba moto yango apema na kimia kino basali ya lisalisi ya liboso bakoya.
5. Kosala ete asanza te: Koluka ata moke te kosala ete mobɛli asanza monɔkɔ to asanza na ndako. Kokanga monɔkɔ elamusaka makasi misisa ya vague, mpe ebimisaka bokóli ya acétylcholine likoló ya noeud atrioventriculaire (AV) oyo esilá kozala na ngɛngɛ ya digoxine, oyo ekoki kosala ete motema ekangama mbala moko mobimba to ekangama ya sinus (asystole).
6. Kebisa ba paramédicaux mpe basali ya lopitalo soki mobɛli azali na digoxine liboso ya kopesa ye calcium IV moko: Soki mobɛli azali na potassium mingi na makila (hypercalémie) na ekzamɛ na bango ya liboso ya makila na lopitalo, sala ete ekipi ya lisalisi ya nokinoki eyeba mbala moko ete mobɛli ameli digoxine to amɛlaki molona ya glycoside ya motema, lokola lisalisi ya calcium intraveineuse standard mpo na hypercalémie ezali na bonkɔkɔ koboya to kozongisama na esika na yango mbala moko Digoxin Immune Fab traitement antidote.

Nzete ya mokano: Triage ya digoxine aigu vs chronique mpe glycoside cardiaque¶

flowchart TD
    Start["Ba suspecter Digoxine to toxicité ya Glycoside ya motema ya milona (Foxglove, Oleander, Lily of the Valley)"] --> CallEMS["Benga na 911 / 112 / 999 mpe Contrôle ya poison ya région; Bomba ete Mobɛli apema na patatalu"]
    CallEMS --> PatternSplit{"Boyeba Motindo ya Présentation Clinique"}

    PatternSplit -->|Acute Overdose: Single Large Ingestion of Pills or Toxic Plant| AcutePath["Physiologie pathologique aiguë: Blocage massif ya mbalakaka ya pompe ya Na+/K+-ATPase"]
    PatternSplit -->|Chronic Toxicity: Gradual Accumulation on Daily Prescription| ChronicPath["Physiopathologie chronique: Ebandisami na bokiti ya rénaux, déshydratation, ba diurétiques, to interaction ya ba kisi"]

    AcutePath --> AcuteLabs["Makambo ya ntina oyo etali mpasi: Kozoka/Kosanza na ebandeli, HYPERKALEMIE oyo emonisami (Sérum K+ > 5,0 kino 5,5 mEq/L), Bradycardie/Block AV; Digoxine ya sérum Extrêmement Haut (Sauf soki Plante Non Digoxine)"]
    ChronicPath --> ChronicLabs["Makambo ya ntina oyo eumelaka: Mikolo ya Anorexie/Nausea, Délirium, Halos ya vision jaune-vert (Xanthopsie), Mbala mingi HYPOKALÉMIE to HYPOmagnémie oyo euti na ba diurétiques; Ba Arrhythmies Ventriculaire na Niveau ya Digoxine Modeste (> 2,0 ng/mL) ."]

    AcuteLabs --> CheckFab{"Mobɛli azali kokokisa ba critères ya antidote ya Digoxine Immune Fab (DigiFab / Digibind)?"}
    ChronicLabs --> CheckFab

    CheckFab -->|1. Any Life-Threatening Ventricular or Brady-Arrhythmia / Shock| GiveFab["KOPESA DIGOXIN INTRAVENAUX FAB IMMUNE MBONGO"]
    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["Gestion ya ICU Post-Fab: Kolandela Potassium ya Sérum malamu (Kozonga noki na kati ya ba cellules epesaka Hypocalémie); Ko Mesurer Re-Mesure TE Niveau Total ya Digoxine na Sérum (Bound Fab Ematisaka Assay na lokuta)"]

Physiopathologie: Ndenge nini ba Glycosides ya motema epesaka ngɛngɛ na motema, bɔɔngɔ mpe miso¶

Kososola lolenge nini digoxine esalaka na niveau cellulaire elimboli mpo na nini esalaka ete kosangisa potassium mingi na makila (hypercalémie), ba blocs ya conduction malembe, arrhythmies ventriculaire hyper-excitable, mpe halos ya vision jaune-vert:

1. Kopekisa ATPase ya Sodium-Potassium ( .Na+/K+-ATPase) Pompe ya kosala¶

Cellule nyonso ya misisa ya motema, selile ya misisa, mpe photorécepteur ya rétine esalelaka motema na sodium-potassium ATPase (Na+/K+-ATPase) pompe mpo na ko pomper 3 ions sodium ( .Na+) LIBANDA ya selile na echange ya ko pomper 2 ions potassium (K+) NA KATI ya cellule contre ba gradients ya concentration na bango.

Tango digoxine to glycoside cardiaque ya molona ekangami na alpha-sous-unité extracellulaire ya Na+/K+-ATPase pompe mpe epekisaka yango, ba réactions en chaîne catastrophiques mibale esalemaka mbala moko:

1. Pile-Up ya potassium extracellulaire (Hypercalémie aiguë):
2. Lokola misisa ya mikuwa mpe baselile ya motema ekoki lisusu te ko pompa ba ions ya potassium na kati ya baselile, potassium etikalaka kokangama libanda na makila.
3. Na surdose aiguë, degré ya hypercalémie sérum ezali baromètre moko ya sikisiki koleka boni Na+/K+-ATPase ba pompe ezali na ngɛngɛ na nzoto mobimba. Yambo ya kobimisa antidote ya anticorps Digoxin Immune Fab, pene na 100% ya ba maladi oyo bazwaki dose eleki ya digoxine aiguë oyo potassium na bango ya sérum elekaki 5,5 mEq/L (mmol/L) bakufaki, nzokande baoyo bazalaki na potassium na nse ya 5,0 mEq/L babikaki.
4. Surcharge intracellulaire ya Sodium na Calcium (Ba Aprèsdépolarisations Retardées na ba Arrhythmies):
5. Lokola sodium ebimaka lisusu te na myocyte ya motema, sodium intracellulaire (Na+) emati makasi.
6. Sodium intracellulaire oyo ya likolo elongolaka gradient oyo esengeli na Exchangeur de Sodium-Calcium (NCX), oyo normalement esalelaka flux ya sodium na kati mpo na kotinda calcium libanda ya cellule.
7. Na yango, calcium intracellulaire (Ca2+) eyanganaka na niveau ya poison na kati ya réticulum sarcoplasmique ya muscle ya motema. Na ba dose ya traitement, mwa bomati ya calcium intracellulaire elendisaka na malembe ba contractions ya motema (inotropie positif). Na toxicité, réticulum sarcoplasmique ekomaka totalement surchargé na calcium mpe esopaka yango moko ba mbonge ya calcium na cytoplasme na tango ya diastole.
8. Ba déversements spontanées oyo ya calcium e déclenchaka ba courants ya sodium transitoires ya kati oyo esala Afterdépolarisations retardées (DADs) na potentiel ya action cardiaque, ebimisaka ba contractions ventriculaire prématuré éctopique, tachycardie auriculaire paroxysmale, mpe tachycardie ventriculaire bidirectionnelle tachycardie létale.
9. Tone Vagal (Paraasympathique) eleki ndelo (Bloque nodal AV):
10. Digoxine e sensibiliser en même temps ba barorécepteurs artériels mpe e stimulaka ba noyaux centrales ya nerf vague, e inondaka noeud sinoatrial (SA) na noeud atrioventriculaire (AV) na acétylcholine.
11. Na yango, motema oyo ezali na empoisonnement na digoxine elakisaka paradoxe moko ya koboma: automaticité supprimée mpe blocage ya conduction makasi na ba noeuds SA mpe AV (bradycardie mpe blocage cardiaque) esangani na irritabilité extrême mpe tir spontané na ba auriers, ba fibres His-Purkinje, mpe na ba ventricules (tachyarrhythmies ectopiques).

2. Mpo na nini Potassium moke (Hypocalémie) esalaka ete ata ba dose ya Digoxine oyo ezalaka na momeseno ezala na ngɛngɛ¶

Ba ions ya potassium ( .K+) mpe ba molécules ya digoxine ezali kobunda mbala moko mpo na esika ya bokangami moko mpenza na libanda ya Na+/K+-ATPase pompe: - Ntango mobɛli oyo azali komɛla dose normal ya digoxine mokolo na mokolo abandi diurétique ya boucle to thiazide (lokola furosemide [Lasix], bumetanide, torsemide, to hydrochlorothiazide) to azwi diarrhee/kosanza, potassium na makila na ye ekiti (hypocalémie, K+ < 3.5 mEq/L). - Na ba ions potassium moke na makila mpo na kobunda na digoxine na esika ya bokangami ya pompe, digoxine mingi ekangamaka mpe epekisaka Na+/K+-ATPase pompe, oyo e déclenchaka toxicité makasi ya digoxine oyo ezali na likama ya bomoi ata soki concentration ya digoxine na sérum oyo emekami ya mobeli ezali na kati to kaka na mpasi koleka intervalle thérapeutique "normal" (1.2 to 2.0 ng/mL). - Hypomagnésium (magnésium moke, eyaka mpe na ba diurétiques) mpe hypercalcémie (calcium ya likolo, oyo ebebisaka surcharge ya calcium intracellulaire) ndenge moko e accélérer ba arrhythmies ya digoxine.

Surdose aiguë vs. Toxicité chronique ya digoxine: Comparaison côté à côté¶

Minganga ya urgence basalisaka empoisonnement ya digoxine aiguë mpe chronique ndenge mosusu mpo ba profils électrolytes na bango, ba temps ya ba symptômes, mpe niveau ya digoxine na sérum e comporter ndenge mosusu:

Ba interactions communes ya ba kisi na ba déclencheur médicales oyo ezo précipiter toxicité chronique¶

Koleka bato 80 likoló na monkama oyo bakɔtaka lopitalo mpo na toxicité ya digoxine esalemaka epai ya bato ya maladi oyo bamɛlaki ata mokolo moko te pilili mosusu; na esika na yango, makoki ya nzoto na bango ya kolongola digoxine ekangamaki na mbalakaka na moko ya mayele mibale:

1. Kozoka ya Rein aigu (AKI) mpe Déshydratation (Filtration Glomérulaire Bloquée):
2. Pene na 70% kino 80% ya digoxine ebimisamaka kozanga kobongwana na ba reins na nzela ya filtration glomérulaire mpe sécrétion tubulaire.
3. Ntango mokóló oyo azali mokóló azwi maladi ya molunge ya eleko ya molunge, gastro-entérite virale (grippe ya estomac), infection ya voie urinaire/sepsis, to abandi ANS (ibuprofène, naproxen) to inhibiteur ya ACE / ARB ntango volume-depleted, taux ya filtration glomérulaire na bango (GFR) ekiti mpe digoxine eyanganaka nokinoki na makila mpe na motema misisa ya nzoto.
4. Ba Inhibiteurs ya Pompe ya Efflux ya P-Glycoprotéine (P-gp) (Ba interactions ya kisi na kisi):
5. Na kati ya misɔpɔ mpe ba tubules proximales rénaux, proteine transporteur ya efflux oyo babengi P-glycoprotéine (P-gp) e pompe activement digoxine libanda ya nzoto na kati ya lumen ya intestin mpe na urine.
6. Kobanda nkisi nyonso oyo epekisaka P-glycoprotéine ekataka bolongoli ya digoxine ya rénaux mpe ya misɔpɔ na 30 % kino 60 %, mpe yango esalaka ete nivo ya digoxine na sérum ekóma mbala mibale na boumeli ya mikolo longola kaka soki bakati mbala moko dose ya digoxine na katikati:
   • Antiarrythmiques: Amiodarone, dronedarone, quinidine, propafenone, mpe flecainide.
   • Ba Bloquants ya Canal de Calcium: Verapamil na diltiazem (oyo ebakisaka pe blocage nodal AV synergique likolo ya niveau ya digoxine oyo ezali komata, ko précipiter blocage ya motema mobimba).
   • Macrolides Antibiotiques mpe Antifongiques: Clarithromycine, érythromycine, mpe itraconazole (macrolides mpe elongolaka bactérie ya intestin lokola Eggerthella lenta oyo normalement e inactiver digoxine na intestin).
   • Ba inhibiteurs misusu ya P-gp: Cyclosporine, tacrolimus, ranolazine, ritonavir/nirmatrelvir (Paxlovid), mpe carvedilol.

Koyeba Digoxin Signature Visual, Neurologique, mpe ECG¶

1. Xanthopsie (Elembo ya Halo Jaune-Vert "Van Gogh") mpe Ba Indices Neuro-Gastro-intestinales¶

Mpamba te ba photorécepteurs ya rétine (mingimingi ba cônes oyo emonisaka langi) ebatelaka courant na yango ya molili na kosaleláká densité makasi Na+/K+-ATPase ba pompes, inhibition ya digoxine ya ba pompes ya rétine ebimisaka ba symptômes visuels incontestables oyo mbala mingi emonanaka avant arrhythmie fatale esala: - Chromatopsie mpe Xanthopsia: Biloko, bifelo, mpe bilongi emonanaka lokola esukolami na langi ya jaune, jaune-vert-vert, to pembe lokola neige, mpe miinda ya kongenga (miinda, miinda ya liboso, écrans ya télévision) ezingami na ba coronas/halos ya jaune-vert to ya pembe oyo ezali kongenga. - Scotomas oyo ezali kongɛnga mpe komona oyo ezali komonana te: Ba taches aveugles oyo ezali kongɛnga, komona na verre glacé, to mpasi mpo na kotánga makomi ya mikemike. - Délirium neurologique ("Encéphalopathie digoxine"): Na ba grands adultes, toxicité chronique ya digoxine ezo imiter mingi mingi démence aiguë, AVC, to maladie psychiatrique, ezo présenter na ba ndoto ya mpasi ya polele, ba hallucinations visuelles, apathie makasi, confusion, agitation, to mpasi ya elongi oyo ekokani na neuralgie trigéminal.

2. Ba résultats ya Électrocardiogramme classique (ECG): "Effet ya digoxine" vs. Toxicité ya digoxine ya solo¶

Digoxine ekoki kobimisa presque arrhythmie cardiaque nionso eyebani longola se ba tachyarhytmies auriculaires oyo esalemaka noki (mpo digoxine ekitisaka noeud AV). Minganga ya minganga basengeli kokesenisa mbongwana ya ECG ya lisalisi oyo ezali na likama te na ba arrhythmies toxiques oyo ekoki koboma moto:

• "Effet Digoxine" (Segments ST Scooped / "Moustache Salvador Dali"): Ezali Elembo ya Toxicité Kaka TE:
• Dépression ya segment ST oyo ekiti, "scooped" (ekokani na marque inverse to moustache ya Salvador Dali), ba mbonge T plat to inversé, mpe intervalle QT mokuse esalemaka na ba malades mingi oyo bazuaka digoxine thérapeutique mpo na répolarisation ventriculaire accélérée na calcium intracellulaire. Na yango moko, "effet digoxine" e prouver kaka que malade azali komela digoxine; ezo prouver te toxicité.
• Ba Arrhythmies Pathognomoniques ya Vraie Toxicité ya Digoxine:
• Contractions ventriculaire prématurée fréquente (PVC) mpe Bigeminie ventriculaire: Arrhythmie ya liboso ya toxicité ya digoxine oyo emonanaka mingi (beat normal nionso elandi na kobeta ventriculaire précoce).
• Tachycardie auriculaire paroxysme (PAT) na Bloc Nodal AV Variable to 2:1: Esangisaka bomati ya automaticité auriculaire (taux auriculaire 150 à 250 bpm) na conduction nodale AV supprimée vagalement.
• Fibrillation auriculaire "régularisée" (Block AV Complète na Rhythme d'Escape Junctionnel Accéléré): Mobɛli oyo azali na fibrillation auriculaire chronique normalement azalaka na pulse irrégulièrement irregulière. Soki mobɛli oyo azali kozwa digoxine mpo na fibrillation auriculaire azwi na mbalakaka pulse parfaitement régulière (ezala malembe na 40 à 60 bpm to accéléré na 65 à 100 bpm), ezali elembo ya drapeau rouge ya bloc AV ya degré ya misato mobimba esika oyo bokutani ya AV ezwi esika lokola stimulateur cardiaque ya kokima mbala na mbala.
• Tachycardie ventriculaire bidirectionnelle: Rythme oyo emonanaka mingi te, pene na pathognomique, mpe ebomaka noki, emonanaka pene na empoisonnement ya makasi ya glycoside cardiaque (mpe VT polymorphe catecholaminérgique familial), esika axe QRS e alternance beat-to-beat na 180 degrés na ECG ya 12 plombs (ebongwani na gauche mpe droite morphologie ya bloc ya branche ya faisceau).

Glycosides cardiaques non pharmaceutiques: Foxglove, Oleander, Lis ya lobwaku, mpe ngɛngɛ ya nyamankɛkɛ¶

Mbala mingi, bato oyo balukaka bilei, bato oyo basalaka bilanga, bana mpe banyama ya ndako bazwaka ngɛngɛ makasi ya glycoside ya motema oyo euti na banzete mpe na ngɛngɛ ya biloko oyo ezali na bomoi oyo esalaka ndenge moko na digoxine oyo monganga akomeli bango:

Kobikisa lopitalo ya sikisiki: Digoxine Immune Fab (DigiFab / Digibind) mpe Protocoles ya ICU¶

1. Antidote définitif: Digoxine Immune Fab (Fragments ya anticorps anti-digoxine ya ngombe) .¶

Digoxin Immune Fab (etekamaki lokola DigiFab to Digibind) ezali na biteni ya bopeto oyo ekangamaka na antigène (Fab) oyo euti na bampate oyo ezwaki mangwele na digoxine. Ntango ekɔtisami na misisa na boumeli ya miniti 30 (to epesami lokola kopusama ya bolus IV nokinoki na arrêt cardiaque to kokweya oyo ezali pene): - Ba fragments ya anticorps ya Fab ezali na affinité ya digoxine oyo ezali mbala 10 à 100 fort koleka affinité ya digoxine mpo na moto Na+/K+-ATPase pompe. - Biteni ya Fab ekangisaka mbala moko digoxine ya ofele na makila, kosala gradient ya concentration ya penza oyo bendaka ba molécules ya digoxine directement na muscle cardiaque mpe ya mikuwa Na+/K+-ATPase ba pompes, kozongisa activité normale ya pompe na kati ya 20 à 60 minutes mpe ko permettre ba reins ebimisa complexe Fab-digoxine oyo ezali na likama te na makila.

Indications officielles pona administration ya mbala moko ya Digoxine Immune Fab:¶

Minganga ya lopitalo bapesaka Digoxin Immune Fab mbala moko tango nyonso oyo MOKO na kati ya ba critères oyo elandi ekokisami: 1. Tachyarrythmie to bradyarrhythmie nionso oyo ezali na likama ya bomoi: Na kati na yango tachycardie ventriculaire, fibrillation ventriculaire, VT bidirectionnelle, blocage AV ya deuxième ou troisième degré ya grade ya likolo progressif, to bradycardie symptomatique oyo ezo répondre te na atropine. 2. Hypercalémie (Serum Potassium > 5.0 to 5.5 mEq/L) na surdose aiguë: Po potassium ya sérum likolo 5.0 to 5.5 mEq/L na empoisonnement aigu ya digoxine esakolaka arrêt cardiaque fatal imminent. 3. Instabilité hémodynamique / Choc cardiogène: Hypotension to hypoperfusion ya organe ya suka oyo ekoki kozala na toxicité ya digoxine. 4. Komela ya makasi to concentration ya sérum eleki ndelo (ata liboso ete ba arrhythmies ebanda): Komela aiguë eyebani ya koleka 10 mg na mokóló (to koleka 4 mg [to > 0,1 mg/kg] na mwana), TO concentration ya digoxine na sérum sima ya kokabolama koleka 10 kino 15 ng/mL (to niveau nionso eleki 2.0 ng/mL na mobeli oyo azali na bilembo oyo ekoki koboma ye).

Dose ya Digoxine Immune Fab (Fiole moko na moko = 40 mg ya Fab, oyo ekangisaka 0,5 mg ya Digoxine):¶

• Concentration ya Digoxine na sérum eyebani (Aiguë chronique to post-distribution): Multiplier Serum Digoxin Concentration (ng/mL) pene Patient Weight (kg) mpe kokabola na 100 mpo na kosala calcul ya motángo ya ba fiole. (Liyebisi: Mabongisi mingi ya toxicologie ezali sikawa kosunga kobanda na 1 kino 2 fiole [40 kino 80 mg] na toxicité chronique stable mpe kozongela 1 kino 2 fiole na miniti 60 soki esengeli, mpo na kopekisa na mbalakaka kosala fibrillation auriculaire rapide to kobeba ya insuffisance cardiaque).
• Eyebani Komela Pilule Aiguë (Milligrammes Miligrammes Eyebani, Niveau Pending): Multiplier Total Digoxin Ingested (mg) pene 0.80 (bioavailability) mpe kokabola na 0.5 mg bound per vial (to kobakisa mingi mg ingested by 1.6).
• Dosage empirique oyo ekoki kozala na likama ya bomoi (Arrêt cardiaque, Dose eyebani te, to Empoisonnement ya Glycoside ya milona/toad):
• Surdose aiguë / Empoisonnement ya Glycoside ya banzete to ya saposo: Kopesa 10 à 20 fiole (400 à 800 mg) IV na ndenge ya empirique.
• Toxicité chronique ya digoxine na instabilité (Niveau encore en attente): Kopesa 3 à 6 fiole (120 à 240 mg) IV na ndenge ya empirique (to 1 à 2 fiole soki ezali stable na ndelo).

2. Mibeko misato ya ntina ya ICU mpe mitambo na Empoisonnement ya Digoxine¶

3. Gestion ya soutien ya ba Arrythmies na ba Électrolytes Tango Ya Kobongisa Fab¶

• Décontamination gastro-intestinal: Kopesa Makala activé à dose unique (1 g/kg kino 50 g) soki mobeli azali na kati ya 1 à 2 heures sima ya komela tablette aiguë to ya nzete mpe azali kolamuka mpe azali kobatela nzela na ye ya mopepe. (Makala activé à dose ebele ekoki pe ko interrompre recirculation enterohépatique ya digoxine na digitoxine soki DigiFab ezali te).
• Kobongisa Hypocalémie mpe Hypomagnémie mbala moko na toxicité chronique: Soki mobeli oyo azali na toxicité chronique ya digoxine azali na potassium moke (< 3.5 to 4.0 mEq/L) to magnésium moke, infuser IV Potassium (ciblé 4,0 à 4,5 mEq/L, soki bloc AV ya grade ya likolo to insuffisance rénale ezali te) mpe IV Sulfate de Magnésium (2 gramme na miniti 15 kino 20). Magnésium ezali cofacteur mpo na... Na+/K+-ATPase pompe mpe e supprimaka ectopie ventriculaire induite par digoxine ata soki magnésium ya sérum ezali normal.
• Bradycardie na AV Block: Kopesa Atropine (0,5 à 1 mg IV) mpo na ko bloquer ton vagal eleki ndelo tango DigiFab ezali ko reconstituer. Bokima ba fils ya stimulateur cardiaque transveineux soki likoki ezali: ko filé fil ya stimulateur stimulateur na ventricule droit irritable, surchargé na digoxine-toxique mbala mingi e déclenchaka fibrillation ventriculaire réfractaire. Salelá Digoxin Immune Fab na esika na yango.
• Tachyarrhythmies ventriculaire: Tango ozali kozela DigiFab, Lidocaine (1 to 1.5 mg/kg IV) to Pénytoïne ( .15 mg/kg IV slowly at <= 25 to 50 mg/min) ezali ba antiarrythmiques préférés mpo e supprimer ba aprèsdépolarisations retardées mpe vraiment ebongisaka conduction nodale AV sans ko déprimer contractilité. Bokima procainamide, quinidine, bêta-bloquants, mpe ba bloquants ya canaux calcium (oyo ebebisaka bloc AV mpe panne ya pompe).
• Bokima Cardioversion Électrique Sauf soki ozali na Arrêt sans Pulse: Kopesa choc électrique synchronisé na malade toxique na digoxine oyo azali na fibrillation auriculaire to tachycardie supraventriculaire mbala mingi ebongoli motema na fibrillation ventriculaire irreversible to asystole. Soki cardioversion ezali inévitable mpo na instabilité oyo ezali na likama ya bomoi liboso ete DigiFab ekoma, salela réglage ya énergie ya nse koleka (10 kino 25 Joules) sima ya kosala pré-traitement na lidocaïne mpe magnésium.
• Pourquoi Hémodialyse ekoki ko effacer Digoxine te: Po digoxine eza na volume ya distribution massive (5 to 8 L/kg) na koleka 90 pour cent ekangami na mozindo na kati ya ba tissus ya mikuwa mpe ya misisa ya motema, hémodialyse mpe hémoperfusion EKOKI TE kolongola digoxine na nzoto (dialyse esalelamaka kaka mpo na ko gérer hypercalémie makasi to surcharge ya fluide na insuffisance rénale).

Mituya ya mbalakaka ya etuka mpe ba protocoles ya agence¶

Mituna oyo batunaka mingi¶

Mpo na nini bato oyo bazali na toxicité ya digoxine bamonaka ba halos jaunes to verts zinga zinga ya ba lumières (xanthopsie)?¶

Baselile ya cône oyo emonisaka langi na rétine ya moto esalelaka mpenza pompe ya ATPase sodium-potassium (Na+/K+-ATPase) oyo digoxine epekisaka na misisa ya motema. Ntango digoxine ekómaka mingi na nzoto, ekangaka bapompɛ yango na rétine, mpe ebebisaka ndenge oyo baselile ya cône ezongisaka polarisation nsima ya komona pole. Yango esalaka ete amona malamu te, azala na sensibilisation na pole ya kongenga, mpe mbongwana ya makanisi ya kala oyo babengaka xanthopsia, epai kuna miinda emonanaka ezingami na ba halos ya jaune, ya vert to ya pembe oyo ezali kongenga mpe biloko ezuaka langi ya jaune-vert.

Mpo na nini ndeko na ngai azwaki ngɛngɛ makasi ya digoxine atako bamɛlaki ata mokolo moko te pilili mosusu?¶

Pene na 70 kino 80 % ya digoxine elongolamaka na nzoto kozanga ete ba reins ebongwanaka. Soki mokóló oyo azali komɛla pilili na bango ya digoxine mbala na mbala mokolo na mokolo azali na kozanga mai na nzoto na ye moke mpo na nyamankɛkɛ ya libumu, molunge ya eleko ya molunge, komɛla mai mingi te, to maladi ya nzela ya makila, to soki bakomeli ye nkisi ya sika lokola amiodarone, verapamil, diltiazem, clarithromycine, to ibuprofène, na mbalakaka ba reins na bango etiki kopɛtola digoxine na esika oyo ezali malamu taux ya taux. Na boumeli ya mwa mikolo mpamba, dose na bango ya mokolo na mokolo oyo bamɛlaka mbala na mbala ekómaka na ngɛngɛ mingi na makila mpe na misisa ya motema, mingimingi soki nkisi oyo ebimisaka mai (pilili ya mai) ekitisaki mpe potassium na makila na bango.

Mpo na nini potassium mingi na makila (hypercalémie) ezali likama na dose aiguë ya digoxine, nzokande potassium moke na makila (hypocalémie) ezali likama na usage chronique ya digoxine?¶

Na dose ya koleka ndelo ya makasi (komela molangi ya bankisi ya digoxine na mbala moko), bomati monene ya digoxine ekangaka bamilio ya ba pompe ya sodium-potassium na misisa ya mikuwa ya nzoto na mbala moko, kopekisa potassium ekɔta na baselile mpe esalaka ete potassium na makila emata kino na nivo ya koboma (hypercalémie). Contrairement, na mutu oyo azali komela digoxine normale mokolo na mokolo na boumeli ya basanza, potassium na digoxine ezali ko compétitionner mpo na esika moko ya bokangami exactement na ba pompes ya motema: soki diurétique to diarrhee esalaka que potassium na makila ekita (hypocalémie), potassium etikali te mpo na kopekisa digoxine ekangama, ko permettre ata dose normale ya digoxine epekisa motema koleka ndelo mpe e déclencher fatal ba arrhythmies oyo esalemaka.

Mpo na nini minganga bazelaka ata ngonga 6 nsima ya komɛla pilili ya digoxine mokolo na mokolo liboso ya kozwa nivo ya digoxine oyo basalaka mbala na mbala na makila?¶

Nsima ya komela tablette ya digoxine, ekɔtaka na makila na boumeli ya ngonga 1 to 2, kasi esɛngaka ngonga 6 to 8 mpo nkisi yango epalangana malɛmbɛmalɛmbɛ na makila mpe ekangama na ba récepteurs oyo elingi kozwa na kati ya misisa ya motema mpe ya mikuwa. Soki laboratoire ebendi makila kaka 2 to 3 heures sima ya pilili normale ya mokolo na mokolo, test ya makila ekolakisa nombre ya "pré-distribution" ya lokuta ya likolo na sérum atako niveau ya tissus na motema ezali totalement normal. Kasi, na likambo ya mbalakaka ya solosolo ya dose oyo eleki makasi, minganga bazali kaka kobenda ba laboratoires ya ebandeli mbala moko pembeni ya potassium mpe ECG wana bazali kobosana te fenetre ya kokabola ngonga 6.

Kolya gant foxglove, oleander, to lis ya lobwaku oyo euti na elanga ekoki kopesa ngɛngɛ ya motema ndenge moko na bankisi ya digoxine oyo minganga bakomaka?¶

Iyo. Foxglove (Digitalis purpurea), oléander commun (Nerium oleander), oléander jaune (Thevetia peruviana), mpe lis ya lobwaku (Convallaria majalis) nyonso ezali na ba glycosides cardiaques naturels oyo epesaka pompe ya sodium-potassium ya motema poison ndenge moko na digoxine oyo monganga akomeli yo. Komela nkasa, bafololo, mboto, tii ya matiti oyo esalemi na nkasa oyo ezali na bilei oyo bakanisaki ete ezali conforte to ail ya zamba, to ata komɛla mai oyo euti na vase ya fololo oyo esimbaki lis ya lobwaku to matiti ya oléander ekoki kosala ete motema ekangama na likama ya bomoi, hypercalémie, mpe arrhythmies oyo ebomaka oyo esɛngaka lisalisi ya makasi na lopitalo mpe antidote Digoxin Immune Fab lisalisi ya monganga.

Ba guides oyo etali yango¶

• Ba urgences critiques ya potassium: Arrêt cardiaque hypercalémique mpe paralysie hypocalémique
• Triage ya surdose ya beta-bloquant na bloquant ya canal calcium
• Koluka bilei ya nguba ya zamba, amatoxine, mpe kolya banzete oyo ezali na ngɛngɛ
• Triage ya secours ya liboso ya empoisonnement mpe ya contrôle ya poison
• Réanimation cardiopulmonaire (CPR) mpe guide ya AED

Maziba mpe bokambi ya Leta¶

• Association américaine du cœur (AHA): Mikolo oyo etalisami na 2023 mpe malako mpo na bozongisi motema mpe mimpululu mpe bobateli ya motema mpe misisa ya mbalakaka: Bokambami ya Empoisonnement Critique (Digoxine mpe Glycosides Cardiaques).
• Association américaine ya ba centres ya contrôle ya poison (AAPCC) & Collège américain ya toxicologie médicale (ACMT): Mabongisi ya pratique clinique mpo na diagnostic mpe gestion ya toxicité aiguë mpe chronique ya digoxine mpe usage ya fab immunitaire ya digoxine.
• Service national d’information des poisons (NPIS, Royaume-Uni): TOXBASE Gestion clinique ya digoxine, Digitalis, mpe empoisonnement ya Glycoside cardiaque.
• EXTRIP (Ba traitements extracorporels na empoisonnement) Groupe de travail: Revue systématique mpe ba recommandations pona traitement extracorporel na empoisonnement digoxine.
• Organisation mondiale de la santé (OMS): Bokambami ya poison na ba toxines naturelles mpe ba plantes glycosides cardiaques (Oléander jaune na gant rerre).

Buku oyo ezali mpo na ntina ya sango mpe ezwi esika ya botalisi ya monganga ya mosala te, botalisi ya Contrôle ya Poison, to ya lisalisi ya nokinoki na lopitalo. Lokola toxicité ya glycoside cardiaque ekoki kokende liboso noki mpo na kosilisa blocage cardiaque to fibrillation ventriculaire, tosengi makasi ozwa cours ya secours ya liboso ya maboko mpe ya CPR oyo epesameli mokanda ya kondimama na nzela ya Fédération internationale ya ba sociétés ya Croix-Rouge mpe ya Croissant-Rouge (IFRC), société ya Croix-Rouge na yo ya ekolo, Ambulance ya St John, to mopesi lisalisi ya mboka oyo andimami.