Intoxication with cardiac glycosides Diagnostics Prevention Emergency care. Required assistance in the case of intoxication with cardiac glycosides. The specificity of the treatment of cordial glycosides poisoning

Intoxication with cardiac glycosides Diagnostics Prevention Emergency care. Required assistance in the case of intoxication with cardiac glycosides. The specificity of the treatment of cordial glycosides poisoning

07.09.2020 Preparations

The greatest sensitivity to drugs of this group is observed among people of old age, as well as patients with diseases of the discharge and blood circulation system, thyroid gland.

Heart glycoside toxicity increases in the case of hypomagnemia and hypokalemia.

Development acute intoxication Glycosides are heartfelt possible, regardless of their ways to enter human body (inward or injecting).

Causes of poisoning

Digital intoxication is most often occurring during the reception of digoxin, since this is the most used medicine among heart glycosides. Significantly less often, and only in the hospital, digitoxin, celainide is used.

Preparations of the presented group have a rather narrow "therapeutic window", i.e. Even the minimum overdose can provoke very serious consequences, cause severe poisoning with a possible fatal outcome. The symptoms of poisoning appear already when the therapeutic dose is exceeded by half, and an increase in this dose of 5-10 times creates a danger of fatal outcome.

Digital preparations have accumulative properties. They bind to plasma proteins and then stay in the bloodstream.

Digitalization intoxication may occur for such reasons:

excess therapeutic dose of the drug;
old age;
severe degrees of renal and liver failure;
diseases of cardio-vascular system: myocardits, ischemic disease Hearts transferred operations and others;
the reduced level of potassium in the plasma of blood, which arises due to the use of diuretic products, and sometimes in the secondary form of hyperaldosteroneism;
the presence of an imbalance of other microelements (hypercalcemia hypercalcemia);
hypoxia states: lung disease and heart failure;
consumption of antiarrhythmic agents - cordaron, verapamil, quinidine;
eating antibiotics macrolides;
thyroid diseases with an increase in the synthesis of its hormones.

When intoxicating with these means there is a powerful electrolyte imbalance in heartcards. Calcium and sodium accumulates in them, but the number of potassium is significantly reduced. Such transformations lead to an increase in the forces of heart abbreviations. At the same time, digoxin reduces the rate of passage of pulses according to the conductive heart system. These changes and lead to the development of digitalistic intoxication.

Clinical picture of poisoning

The first signs of intoxication by drugs are detected on the ECG, when the poisoning clinic is still missing. Electrocardiogram demonstrates a variety of disorders heart Rhythm:

tachycardia (heartbeat);
blockades;
extrasystole (extraordinary myocardial cuts);
fibrillation ("fluttering") of ventricles and atrium.

Other changes are observed, but they can detect only qualified doctors. If you do not start help on early stage intoxication, start manifest clinical symptoms.

There are several groups of clinical signs.

Symptomatics of the lesion of the heart muscle:

arrhythmia, cardiac arrest;
signs of ischemia (intense stubborn pain).

Defeat of the gastrointestinal tract:

diarrhea;
lack of appetite;
vomiting;
nausea.

Neurological changes:

insomnia;
fatigue and weakness;
dizziness;
psychosis;
depression;
migraine.

Defeat organs of vision:

points and stains before your eyes;
violation of color perception (yellow-green tones predominate);
afraid of bright light;
fuzzy and blurred image;
blindness.

The sharp form of poisoning is characterized by rapid (after a few minutes or hours after the use of digoxin) the development of a pronounced clinic. At the same time, the patient's condition deteriorates sharply, which is accompanied by convulsions, a fall in blood pressure and a stop of the heart.

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The specificity of the treatment of cordial glycosides poisoning

In the case of intoxication, digoxin is important in time to provide first aid and proceed to treatment. As for therapy, it consists of an appropriate number of important events:

cancellation of cardiac glycosides;
the removal of toxins from the human body. To do this, it is necessary to take appropriate sorbents: activated carbon, polysorb, smacks, attoxyl, etc., then rinse the stomach, but this is carried out only in emergency cases. Sometimes saline laxatives are used: sodium sulfate or magnesium, as well as Salt Karlovyar;
in severe cases, potassium chloride intravenously is introduced, and in lighter - inside, but only after meals;
the choice of arrhythmic drugs depends on the type of arrhythmia;
specific antidotes for heart glycosides are digitalis antidot bm and unitiol;
in rare cases, electrocardialization is carried out;
symptomatic therapy includes intravenous administration of saline and glucose, the use of psychotropic drugs, as well as hydroxiotherapy.

Prevention of digitalistic intoxication

Prevention of poisoning with drugs in the drugs consists in a thorough selection of dose of the drug. Take glycosides only by appointment of a doctor!

The course of treatment should be accompanied by the constant control of the dynamics of the ECG, as well as the level of blood electrolytes (control of potassium concentration is most important).

The patient must inform the doctor-cardiologist about the preparations that it takes for the treatment of concomitant diseases (antibiotics, diuretic, antiarrhythmic, etc.).

Be sure to include in the diet of products rich in potassium (smoking, prunes, raisins, potatoes in the peel).

Thus, a very dangerous and insidious phenomenon. If you do not give timely help and not start therapy, a person may die due to stopping the activities of the heart muscle.

Emergency Medicine

The greatest toxicological interest is cumulating heart glycosides and drugs from different species Digitoxine, gytoxin, celands, Lantoside, Digal neo and others, as well as adjacent to them by the pharmacological properties of glycosides from oleander. Absorbed with a different speed of the stomach and intestine: drugs in the purple slow, woolly (cesside) - quickly.

In the blood, they are adsorbed by blood plasma proteins, are distinguished slowly (cumulating) by the kidneys.

The poisoning of inethist and its drugs may occur either due to an overdose, or with long-term use due to the ability of this group of heart glycosideos of ku-mulalo in the body, as well as due to increased sensitivity.

The deadly dose of the leaf of vyfrestyanka and the bulbs of the sea onion 2-4 g, digitoxine - 2-4 mg; For other digitalis-like drugs, it is 20-50 times more supportive dose.

Pathogenesis and symptoms of poisoning. In the pathogenesis of poisoning with cardiac glycosides of the group of inensitial, the deterioration of the heart of the heart is important live action Toxic doses of these drugs, as well as direct influence on the central nervous system, in particular, stimulating effects on centers wandering nerve. As a result of a sharp deterioration in the atrial ventricular conductivity and increasing excitability, significant violations of the heart rhythm may occur: extrasystolia, bigemia, partial or complete atrioventricular blockade with atrial flications, tachiisistol and paroxysmal tachycardia of ventricular origin. The impact on the central nervous system, in particular the stimulation of the dump center, causes anorexia, nausea, vomiting. Less often observation of neuropsychiatric disorders associated with the hypoxic shifts and the influence of drugs on the activities of the large brain cortex (motor arousal, nonsense, convulsions, loss of consciousness). The inhibition of diuresis is noted during the level of poisoning is associated with a central disruption of the function of the wandering nerve and with spasm of renal vessels.

Symptoms of acute poisoning of cardiac glycosides: anorexia, nausea, stubborn vomiting, Icota, chic-shaped pain in the supry region and abdomen, diarrhea with a delay of diuresis. The pulse is sharply slow, incorrect. Rhythm disorders - from individual extrasystole, bigemia before the flickering of ventricles, ventricular paroxysmal tachycardia (with a complete atrioventricular blockade). Changes are characterized by ECG - lengthening the Rq interval, the shift of the ST segment under the iso-electric line. Maybe vision: Xantopsy, diplopia, photophobia, etc. Pupils are expanded (less often narrowed), observed exophthalm, eye-minded muscle pares.

Noted headache, weakness, drowsiness, with severe poisoning - nonsense, shortness of breath, cyanosis, comatose, convulsions, decrease in blood pressure, ventricular fibrillation, cardiac arrest in the diastology stage.

Symptoms of irritation of the digestive system (colic, vomiting, diarrhea) clearly manifest themselves in the poisoning of oleander and its preparations.

First aid and treatment with cordial glycosides poisoning. Washing the stomach through the probe by the suspension of activated carbon (20-30 g in 1 liters of water) or 0.2-0.5% tannine solution with the subsequent introduction of a saline laxative and cleansing enema. Validative means for poisoning with drugs against the drugs and their analogues are contraindicated. The toxic effect of cardiac glycosides on myocardium (arrhythmias, cardiogenic collapse) is stopped by potassium chloride. With a normal kidney function, the latter is prescribed (in the absence of vomiting) through the mouth of 0.5 g (dissolved in water) every 15 minutes or in the form of a 0.3% solution of potassium chloride (in 5% glucose solution) slowly intravenously - until So far, the ECG will not be noticeably improved or the content of potassium in the blood will not increase to 5 mmol / l.

With a reduced kidney function, it is necessary to pre-determine the content of potassium in serum before administration of potassium chloride. Maximum dose Potassium chloride in the first day after poisoning - 4 g; In the following day - 2g. 20 ml of 10% of the Tetasche Calching solution with a 300 ml of a 5% glucose solution are injected intravenously.

To reduce the toxic effect of cardiac glycosides, unitiol is used (intramuscularly 5 ml of 5% solution 4 times a day) and a ditrium salt of EDTA (2-4 g of a 5% glucose solution intravenously drip for 3-4 hours).

Anaprilin is used (10-30 mg 3 times a day), Novocain-amid inwards in 0.5-1 g each 2 h (only up to 4 g) or intramuscularly at 5-10 ml of 10% solution 3-4 times in Day, as well as chinidine sulfate - inside 0.2 g 3-4 times a day, Novocaine - intravenously 2-5 ml of 0.25% solution 2-3 times a day. Sharp bradycardia, nausea, vomiting will be bought re-administration Atropine sulfate (0.5-1 ml of 0.1% solution under the skin).

To combat dehydration of the body, the parenteral administration of fluid (isotonic sodium chloride solution, 5% glucose solution) is recommended. Inhalation of oxygen is used to eliminate hypoxia. Excitation phenomena are bought by barbiturates. In the case of a cardiogenic collapse, vesseloring agents (adrenaline hydrochloride, norepinephrine hydrotatch) may determine the occurrence of ventricular fibrillation and therefore are contraindicated. In the treatment of acute poisoning with cardiac glycosides, a strict bed regime is required.

Treatment of acute poisoning, 1982

Poisoning cardiac glycosides

Cardiac glycosides are cardiological medicines vegetable origin, one of the main groups of drugs in complex therapy acute and chronic heart failure. These include digoxin, digitoxine, stanfantine, korglikon, celainide.

The vegetation substrate for heart glycosides is a sprinkler, the Gorizet Spring, the Lily of the Mayan, the Justice, Strafante and others.

The main effect of the means of this group is cardiotonic, it is manifested by an increase in the strength of the reduction of the heart. In addition, it is characterized by a negative chronotropic (demolition of heart rate), and negative drromotropic (slowing down the velocity of nerve pulses along the heart tissues) effect.

When applying in therapeutic doses, cardiac glycosides reduce tachycardia, eliminate shortness of breath and swelling, accompanying heart failure, contribute to the improvement of peripheral blood circulation.

How is the poisoning of cardiac glycosides?

An dangerous undesirable effect when taking glycosides in the suboxy or toxic doses is their ability to increase the excitability of heart structures, thereby provoking heart rate breakdowns.

Basic by-effect Heart glycosides is glycoside, or digitalis, intoxication - life-threatening condition.

Heart glycosides is often encouraged: to varying degrees, it is subjected to in various data, from 15 to 24% of patients receiving drugs. This is due to the peculiarities of suction, the distribution of glycosides in the systemic bloodstream and their elimination.

Therapeutic latitude (the interval between the minimum dose causing the therapeutic effect and the minimum dose causing side effects) In the means of this group, it is extremely small, which significantly limits their use, despite their effectiveness.

The deadly dose is only 5-10 times the dose that causes the therapeutic effect, and the first symptoms of intoxication appear when a healing dose is exceeded by 2 times.

The development of acute glycosidic intoxication is possible in several cases.

Poisoning in individuals receiving the therapeutic dose of the drug:

elderly patients;
patients with heart conduction disorders, unstable angina, acute myocardial infarction;
history in history, liver, renal failure, hypothyroidism, electrolyte violations;
in the case of individual hypersensitivity to glycosides;
reception of cardiac glycosides is accompanied by a parallel reception of 3-4 and more than other drugs, etc.

Nevertheless, more often, acute poisoning occurs with incorrect reception of the medicinal product:

independent increase in the multiplicity of reception or dose;
reception of the drug without appointing a doctor;
reception by mistake instead of another drug;
consumption of heart glycosides with suicidal purposes;
drinking children during games.

Symptoms of poisoning

Symptoms of acute poisoning with heart glycosides can be distributed into 3 groups: dyspeptic, neurological and actual cardiological disorders.

The manifestations of the gastrointestinal tract are associated with the irritant action of glycosides on the mucous membrane of the stomach and intestines:

Neurological disorders manifest:

fast fatigue;
headache, dizziness;
pronounced drowsiness or vice versa, insomnia;
nightmares;
concern;
convulsive syndrome;
confusion of consciousness, psychosis and delirium.

The characteristic manifestation of acute glycoside intoxication is specific impairment of vision: yellow or yellow-green glow around the objects (xantopsy), increasing when viewed on the light source, reducing visual acuity, the perception of objects in a reduced or enlarged form, photophobia, loss of fields.

The symptoms of acute poisoning of heart glycosides on the part of the cardiovascular system are the most dangerous and manifest, as a rule, violations of heart rhythm and conduction:

interruptions in the work of the heart;
feeling of heartbeat fading;
pain in the chest;
sharp weakness;
decrease in blood pressure;
tachycardia, sometimes paradoxical bradycardia (less than 50 blows per minute);
fundy episodes.

Most often, cardiological symptoms are preceded by dyspeptic and neurological.

First aid with heart glycoside poisoning

If glycoside intoxication arose during the injection with the drug, it should be immediately discontinued.

Acute cordial glycosides requires immediate measures:

Provide a victim full motor and emotional peace.
Disseminate shy clothes, open the windows, ensuring fresh air access.
Accept enterosorbent (athoxyl, polyfepan, enterosgel, polysorb).
Take a salt laxative (magnesium sulfate).

Washing the stomach during acute poisoning with cardiac glycosides is not recommended, since it may lead to an increase in parasympathetic tone and thereby aggravate the state of the victim.

When is medical care required?

Since glycoside intoxication is a serious, life-threatening condition, medical care is mandatory in all cases.

The team of emergency medical care must be caused if symptoms from at least one of the systems (digestive, nervous, cardiovascular) appeared on the background of taking drugs.

Under the hospital, qualified assistance will be provided to the victim:

correction electrolyte violations (introduction of potassium, magnesium, sodium drugs);
oxygen therapy;
introduction of specific antidotes (5% unitary, ethylenediaminetetrauxous acid, 2% solution of sodium citric acid);
the introduction of antidigitoxin (Fab fragments of antibodies to digoxin), which completely eliminates the cardiological disorders for 0.5-1 hours;
the introduction of antiarrhythmic agents if necessary;
with the ineffectiveness of antiarrhythmics - electrocardialism and cardioversion.

Possible consequences

The main consequences of cordial glycosides poisoning are violations of rhythm and conductivity, which can lead to the death of the victim:

fibrillation and fluttering atrial;
ventricular fibrillation;
atrioventricular blockade;
sharp bradycardia (less than 50 shots per minute);
heart stop (asistolia).

How to help man in glycoside intoxication

Glycoside intoxication is a condition of acute or chronic poisoning by drugs of Digitalis Group, used to treat heart disease. Cardiac glycosides - substances secreted from a sparking plant (on Latin - Digitális), they are used to treat chronic heart failure. As a rule, this is the most commonly prescribed by the heart disease "Digoxin" or appointed in the Digitoxin or Zelanide hospital.

The essence of intoxication is that electrolytic balance is broken in heart cells and an excessive amount of calcium and sodium accumulates, and the potassium content decreases sharply. As a result, cardiac abbreviations are enhanced. In addition, the conductive heart system is disturbed, and the impulses arise in those areas of the heart muscle, where it is not provided in normal functioning, and in general, the pulses slow down in the heart.

Often, this severe complication arises due to overdose of cardiac glycosides (they have very strict therapeutic "borders" and exceed the necessary dose too easy). Also, intoxication with heart glycosides may occur at a normal concentration of drugs in the blood due to a decrease in the body tolerance to drugs that manifests themselves due to a number of reasons:

Old age (and as a result is a violation of resistance to any stressful impact, as well as deterioration in the quality of all organs and systems and slowing the metabolism).
Disruption of the thyroid gland.
Renal failure (problems in the operation of the excretory system, which is why toxic substances accumulate, not separated from the body), as well as liver failure (the absence of the body to effectively fight toxins effectively).
Diseases of the circulatory system (problems with circulation of substances in the body also lead to a similar effect, because blood is its main transport system).
Pathologically low content in the body of magnesium and potassium (for example, in the reception of diuretic preparations that take potassium from the body), an excessively high calcium content.
Low oxygen content in the body (hypoxia) due to heavy heart failure or erect diseases.
Previously transferred heart operations, angina, myocardial infarction and its consequences.

In addition to patients with cores, people who are ineptly using drug plants or persons who take suicide attempts are subjected to risk of digitalistic intoxication. However, it should be noted that the death dose of heart glycosides is an order of magnitude exceeds the therapeutic, so the error in the reception of drugs in most cases leads to poisoning, but not to death.

The phenomenon of intoxication with cardiac glycosides is quite common, this state occurs from 5 to 25% of patients constantly receiving Digitalis preparations (spinning) or other heart glycosides.

Symptoms of cordial glycosides poisoning

For timely and correct assistance, it is very important to establish on time, with which we actually deal with. To do this, it is important to know clinical picture Digital intoxication - what it is, as the main syndromes appear and what are the main syndromes. There are several of them:

gastrosinrome (violation of work gastrointestinal tract), manifested in the form of a pronounced reduction or complete absence of appetite, nausea, inexperienced vomiting with yellow (less often with blood), diarrhea and as a result of dehydration of the body, as well as abdominal pain;
headache and dizziness due to violation of the central work nervous system;
neurological syndrome in the form of convulsion, overexcitation or, on the contrary, depressive state, insomnia or the appearance of nightmares, sometimes - nonsense and hallucinations;
impairment of vision and reduction of its acute up to blindness, photophobia, appearance before the eyes of green or yellow spots, dots;
respiratory disorders: shortness of breath, hypoxia (oxygen starvation) and as a result - cyanosis (bluish skin shade);
cardiovascular disorders - extrasystolia, bradycardia, tachycardia, flickering arrhythmia; In addition, digitalistic intoxication on the ECG is detected quite easily: the rhythm disorders and all types of conductivity are determined (especially alarming signs that can lead to death due to suffocation or cardiac arrest, the development of ventricular extrasystolia, paroxysmal tachycardia and the flickering of atrial and ventricles are considered) .

First aid for digitalistic intoxication

It is important to remember that the stronger the degree of intoxication, the more symptoms are expressed, and the faster they manifest themselves (in minutes or hours after receiving the drug). In this case, the condition is rapidly deteriorating, so the help should be immediate. This state requires the use of antidotes and resuscitation activities.

First, it is necessary to stop using heart glycosides (cancel the drug).
Next follows a number of measures to eliminate toxic substances From the body: the use of salt laxatives (through the probe) and the appointment of activated carbon to absorb toxins and prevent their further suction (stomach washing is recommended only in extreme cases).
It is also necessary to stop the circulation of the poisoning substance in the body, for which they are taken inward, for example, vaseline oil.
Appointed oxygen inhalation and intravenous administration of glucose with insulin, vitamin B 6.
A very important task is the normalization of heart rhythm and cardiac conduction by the use of funds against arrhythmia (up to electrocardialization and defibrillation, if drugs do not help).
If the victim is over-excited, neuroleptics are introduced intravenously.
The contractile function of myocardium is regulated by reducing the effect of calcium by the introduction of calcium channels.
Myocardial excitability is normalized in the case of arrhythmia or cardiogenic collapse, introducing calcium thetacine in the glucose solution or in isotonic solution.
With potassium insufficiency (hypokalemia) prescribe potassium preparations.

In any case, if there is a digitalistic intoxication, the treatment must only be prescribed and carried out in its hospital in it.

Antidote heart glycosides

The antidote of the digoxin is the binding of free digoxin in the body and the termination of its interaction with myocardial cells. The antidotes perform fragments of antibodies against digoxin in an amount adequate dose of the glycoside, which was suspended in blood (the dose calculation formula is always attached to the instructions for the antidotide drug). After half an hour after receiving the antidote, the organism grows the content of glycoside, it is connected to the protein, loses its activity and is derived from the body.

Since the antidote is obtained by the synthesis of antibodies formed in the body of sheep, in people who previously obtained preparations containing a sheep or chicken egg protein can be observed an allergic reaction.

Treatment of digitalistic intoxication

The treatment diagram is as follows:

introduction of antidote by the introduction of drugs "Unitiol", "Digibine" or "Digitalis-Antidote BM";
elimination of barycardia and vomiting with atropine sulfate;
arrhythmia is removed by the administration of diphenin or polarizing mixture (glucose, potassium chloride, insulin and cocarboxylase);
normalize heart activities with riboxin;
fill the loss of moisture by the body as a result of dehydration, introducing infusion solutions;
in the presence of cramps, they remove them with anticonants;
general state the body is improved by appointing a course of vitamins and oxygen therapy;
in the absence of positive dynamics, hemosorption is carried out, heavy cases - hemodialysis.

Prevention of cordial glycosides poisoning

If you are forced to take cardiac glycosides for the treatment of chronic heart failure, in no case do not exceed the dosage and pay attention to the slightest negative changes in your condition listed in the list of symptoms of intoxication with cardiac glycosides. Even a small increase in the dose can lead to sad consequences and even to death, moreover, it should be borne in mind that cardiac glycosides have a property of accumulating in the body.

If you are engaged in grass and are a fan of phytotherapy, it is important to remember that the poisoning of cardiac glycosides can occur mainly when using a pesting as a medicinal plant (also a similar effect can give poisoning such plants as oleander and Lily Mayan). It is important to know that at present, any independent use of ingredients as a medicinal plant is prohibited. how medicinal plant Stewish was used in the treatment of the heart, as well as to reduce the edema and strengthening of urinations. It is known at least 4 thousand years old, in Europe, it has already been popular already in this, however, due to frequent cases of poisoning, it periodically fell under the ban. But in the 18th century, the Glycoside of Digitalis was opened in the UK, however, it was used extremely careful because of the complexity to choose a safe, but effective dose (an overdose occurs extremely easy due to high toxicity). In a word, in a word, a classic illustration of the immortal span of Paracelles: "Everything is poison and everything is a medicine, it's only a dose."

Poisoning of cardiac glycosides, symptoms, emergency care

Digitalization intoxication (heart glycosides poisoning) is a severe complication of the treatment of patients suffering from heart disease and receiving drugs of Digitalis Group (Digoxin).

The lethal doses of heart glycoside drugs are usually 10 times and more exceeding therapeutic. Especially sensitive to them the elderly, patients with impaired thyroid gland, blood circulation and selection system. The toxicity of the means of the digitalis group increases in the presence of hypokalemia, hypomagnemiology. Children are more resistant to them.

The duration of the toxicogenic stage correlates with the speed and completeness of the absorption of heart glycosides in the gastrointestinal tract, the binding speed by their plasma proteins and excretion. It is rather long in people with intoxication, poisoned by digitoxine and isolanide, through heputocyish circulation and significant reabsorption in the kidneys. In particular, Digitoxin is associated with plasma proteins by 90%, digoxin - by 40%, stroofitin - less than 10%. Daily, the activity in the blood of stanfantine decreases by 40-50%, while digitoxine is 7-10%. Due to the low (3.5%) absorption in the Zhkt Prafantine and Digitoxin, oral poisoning is not registered with them.

Manifestations of acute poisoning with heart glycosides do not depend on their ways to enter them into the body.

Clinical symptoms of cordial glycosides poisoning

The clinical picture of digitalistic intoxication consists of several leading syndromes, in particular:

gastrointestinal
cardiovascular
psychoneurological I.
vision disorders.

First of all, dyspeptic manifestations appear in the form of nausea, continuous vomiting with admixture of bile in the vomit masses, sometimes blood, diarrhea, signs of dehydration of the body, abdominal pain. Soon there is a headache, dizziness and impairment of vision in the form of ring-shaped cattle, xantopsy, a decrease in visual acuity, as the result of the development of retrobulbar neuritis. Ataxia, insomnia, excitement, nonsense, hallucinations, convulsions, shortness of breath, cyanosis, hypoxia, reduction of diuresis are also characteristic.

On an ECG, along with a decrease in the interval ST and a negative or disconnected Tusten T, the interval PQ is extended, the unit's single atrial teeth fall out, the rhythm disorders and conductivity of all types are often noted, especially when acute poisoning of cardiac glycosides preceded violations of cardiac activity: bradycardia, blockade and Edd .. Very dangerous is the development of ventricular extrasystole in the type of bigeninia, paroxysmal tachycardia, the flicker of atrial and ventricles. In such cases, death occurs due to stopping heart or asphyxia.

Emergency Assistance in Digital Incication

Emergency Presence Program for acute intoxication Heart glycosides provides for early disinfecting by resuscitation measures and antidotes, interrupting enterogetic circulation (if the poisoning occurred to digitoxine or isolanide), eliminating the manifestations of PSKE, arrhythmias, vomiting, excitation and hypoxia, improving the contracting function of myocardium. For this you need:

a) stop treating cardiac glycosides;
b) enter unitiol, vitamin E and glycocorticoids to reduce PSKE manifestations in the first time, in subsequent days;
c) re-rinse the stomach, introduce salt laxative and activated carbon through the probe to prevent the absorption of poison in the gastrointestinal suction. Also take inside 200 ml of vaseline oil or 8 g of cholestramine, which will ensure the cessation of circulation if the intoxication is caused by dihytoxyin or isolanide;
d) ensure the inhalation of oxygen, infusion 5-10% glucose with insulin, cocarboxylase, vitamin B6 intravenously;
e) normalize the rhythm and conductivity of the heart with anti-erroximal means, with the exception of Novocainamide and Cynidine, which are contraindicated. In the absence of effect - to carry out electrocardialization or defibrillation of the heart;
e) in the presence of vomiting and excitement introduce a parenteral diprage 1 ml of 2.5% solution, Promedol 1 ml of 1% solution or one of the neuroleptic means (dropridolml 0.25% solution or aminezinmillillete 2, 5% solution). As an antiarrhythmic agent to use the polarizing mixture;
e) reducing the effect of endogenous calcium on the contractile function of myocardium due to the disodium salt of ethylenediaminetetraacetic acid 3-4 g of 500 milliliters of 5% of the glucose intravenously drip, 2% solution of sodium citrate 5 ml / kg verapamila 1-2 millilita 0.25% solution or other calcium channel blockers (phenihydine etc.);
g) to normalize myocardial excitability (during arrhythmias, cardiogenic collapse) introduce intravenously drip 10% thetacin calcium in a 5% glucose solution or isotonic solution of sodium chloride in one-time dosage / kg, in dailymg / kg;
c) in the presence of hypokalemia to use potassium preparations (Panangin, potassium chloride, potassium and sodium asparaginat).

Antidote when poisoning with cardiac glycosides

Specific antidote with digital intoxication with cardiac glycosides, in particular digoxin preparations, are fragments of specific antibodies against digoxin. The essence of their antidototype activity is to bind free digoxin contained in the plasma after its absolute or relative overdose, and in preventing its interaction with myocardial cells. The drug is used in a dose, molecularly adequate quantity of glycoside of instrettening, which sat down. (Empirically found that this dose is 800 mg, that is, 20 ampoules of 40 mg).

Fragments of specific antibodies against digoxin are obtained from specific antibodies that were formed in the body of sheep. Their relationship with digoxin, as well as digitoxin and the launchoside, is greater than the relationship of these glycosides with specific receptors (ATP-Aza) in myocardium. Therefore, these glycosides are connected mainly with fragments of specific antibodies, and not with specific receptors in myocardium and other tissues. 30 minutes after the introduction of the antidote, the content of digoxin or another glycoside begins to grow in the blood, which promotes intoxication, connected to protein of glycosides lose pharmacological activity and are derived from the body. The dose of the drug is installed individually and depends on the amount of glycoside, which sat down.

The dose calculation is carried out according to the instructions applied to the pharmaceutical preparation.

Digital Incication - Treatment

An undesirable complication when applying a digitalistic antidote can be an allergic reaction in sensitized patients, which previously administered preparations containing a sheep protein or protein. chicken egg. So, have the following drugs: DIGIBIND (DIGIBIND) - Capsules of 40 mg of lyophilized fragment of antibody against digitoxine; DiGitalis antidot BM - ampoules of 80 mg fragment of the antibody against digoxin (dry substance).

The wagomimetic effect of cardiac glycosides (bradycardia, vomiting) should eliminate atropine sulfate - 0.5-1 milliliter 0.1% solution. In the presence of arrhythmias that arose due to digitalistic intoxication with heart glycosides, diphenine is used or polarizing mixture (100 ml of 10% glucose + 0.5 g potassium chloride + 2 dams + mg of cocarboxylase). In order to improve cardiac activity, riboxin is used.

Dehydration of the body is eliminated by the introduction of infusion solutions: 5% glucose with insulin, cramps - anticonvulsant means (sodium by oxybutirate, sybazone, aminazine). The vitaminotherapy and oxygen therapy is shown.

In the absence of positive results, it is advisable to conduct hemosorption, and with severe poisoning with digoxin or stained hemodialysis, introduce specific antibodies.

Poisoning cardiac glycosides

Cardiac glycosides belong to the group of medicines necessary for the treatment of heart failure. Course or one-time use of these drugs ensure the efficient work of the heart, positively affecting the state and functioning of myocardium.

Incication of cardiac glycosides is explained by certain characteristics of these drugs, which contribute to the accumulation of the drug in the body and can cause serious pathological changes.

Cardiac glycosides are prescribed on strict indications. In this group there are preparations with an instant therapeutic effect, and they are used to relieve acute states.

Other types of heart glycosides are prescribed for long-term treatment, in the process of which their dose adjustments should be carried out constantly.

Causes of glycosidic intoxication

Glycosidic intoxication in most cases occurs in patients using these drugs to treat heart disease. It is less likely to develop this condition in people who receive the drug for suicide, even less often an overdose occurs in case of accidental use of plants containing glycosides.

Inxication of glycosides occurs when the dosage of these drugs is exceeded. Female outcome can be observed if the one-time dose is 5-10 times higher than the designated therapeutic.

Sensitivity to cardiac glycosides increases in certain diseases and conditions of the body, the provoking factors include:

Elderly age.
Diseases occurring in disruption of the functioning of the thyroid gland.
Hypokalemia, that is, the accelerated removal of potassium from the body.
Hypomagnia.
Myocardial infarction and post-infarction cardiosclerosis.
Renal and liver failure.
Hemodialysis.
Operational interventions on the heart muscle.

When prescribing heart glycosides, the doctor must carefully examine anamnesis and only after that select the necessary dosage.

Intoxication with cardiac glycosides may begin to develop a few weeks after the use of the first dose. Such glycoside as a digoxin used to treat in old age has a tendency to accumulate in the body. Therefore, its dose after treatment for several days should be adjusted towards the decrease.

In the elderly, an overdose often arises due to their memory problems and therefore the reception of glycosides in old age should control relatives.

Signs of overdose

Glycosidic intoxication is manifested by a decrease in the number of heart abbreviations, extrasystole, the damage to the gastrointestinal tract, which is expressed by nausea and vomiting.

The symptoms of intoxication are made up of gastroincentsial, psychoneurological, cardiovascular syndrome, vision disorder is also joined. Acute poisoning of cardiac glycosides can be suspected if the following symptoms are recorded:

Signs of violation of rhythm - bradycardia, extrasystole, flickering arrhythmia. Tachycardia developing after bradycardia and a period of a normal number of heart abbreviations.
Symptoms of violation of the functioning of the gastrointestinal organs. It is manifested by nausea, stomach pains, vomiting. In chronic overdose, anorexia is developing.
Symptoms of TSN damage. Heart glycosides in a large dose lead to the development of hallucinations, depression, strong headaches and dizziness. Delium develops in patients, in chronic poisoning, nightmares are worried.

Acute poisoning affects the emergence of visual changes. You can pay attention to the fall in view, the appearance of yellow and green spots when looking at the object. The patient is worried, he has the sinusiness of the nasolabial triangle and lips, hypoxia, shortness of breath, in severe cases of convulsions and coma.

Inxication of glycosides can be detected after the ECG. The Cardiogram is extended by the PQ interval, a negative or reinforced prong, the conduction and rhythm is noticeably revealed.

Dangerous is the development of ventricular extrasystole, atrial flicker. Death in the overdose of glycosides occurs due to the stop of the heart or asphyxia.

First aid for glycosidic intoxication

If the symptoms of intoxication of cardiac glycosides are fixed, then it is necessary to act according to the following scheme:

Cancel treatment with cardiac glycosides.
To carry out the early disinfect and the introduction of specific antidotes.

In acute poisoning, early disintellation should be aimed at reducing the concentration of the drug in the stomach, for this purpose they are carried out:

Washing the stomach. In a hospital, a salt laxative and coal activated is introduced through the probe, which will reduce the absorption of glycosides in the organ wall. If it is known that the poisoning occurred isolanide or digitoxine, then 200 ml of vaseline oil can be introduced. This will reduce the circulation of drugs in the blood.
When vomiting it is necessary to create conditions that prevent the aspiration by the vomit masses.
Glycosides poisoning requires medical care in the hospital and therefore, when fixing this state, ambulance is called immediately.

The treatment in the hospital includes the following activities:

Introduction of unitiol, glucocorticosteroids, vitamin E. Dosage of these drugs is selected by a doctor.
Cardiac rhythm is normalized by antiarrhythmic drugs. The exception is Novocainamide and County. In the absence of the effect of these funds, it is carried out defibrillation.
The victim is provided in inhalations with oxygen, 5% glucose solution with insulin is introduced.
In vomiting, diprazine, commotol, droperidol are introduced.
As antidot is used sodium citrate, a diodium salt in dilution with glucose.
In pronounced bradycardia and the synoyatrial blockade, atropine is subcutaneously introduced.
During tachycardia, faith is effective.
In the detection of hypoglycemia, potassium preparations are prescribed.

After conducting all resuscitation measures and stabilizing the state of the patient with positive dynamics on ECG, it is necessary to conduct medical observation within a few days. A favorable forecast is exhibited if during the day after poisoning the patient's condition is normalized.

Overdose with cardiac glycosides

Mortality from cardiovascular diseases today is quite high. Therefore, cardiological preparations are usually available everywhere and many of them are sold without a recipe. A rather significant part of this group is digitalis drugs that are prescribed during heart failure.

These substances used in the weakness of cardiac activity are one of the vital drugs that are primarily necessary for older people.

However, only the correct dosage of the means will provide a good therapeutic effect.

Applied with the weakness of cardiac activity

The process of absorption of drugs is rather complicated, even an insignificant deviation from the designated dose can play a cruel joke: instead of the desired improvement in the state, the patient has glycoside intoxication.

Features of drugs

Glycosidic substances are able to restore the balance of minerals in the heart muscle for its normal operation. Excellent copes with heart failure, weakness of the heart muscle, bradycardia and tachycardia.

However, only an accurate dose will help the patient feel much better. The overdose of cardiac glycosides may occur even with an insignificant excessive substance that has the ability to accumulate. That is why the first symptoms of overdose of heart glycosides may occur after a day, two after an increase in the dose used.

Basic symptoms of poisoning

Heap glycosides poisoning affects the work of such systems of the human body:

gastrointestinal tract;
nervous system;
excretory functions;
cardiovascular system.

Glycosidic intoxication weak degree It may slightly worsen the patient's condition. If it was an extraordinary tablet, which a man accepted on elementary forgetfulness, then intoxicating cardiac glycosides can resemble food poisoning.

Emergency care for glycoside intoxication with cardiac drugs is necessary if such symptoms occur:

violation of vision (visual color hallucinations appear, prevailing colors - yellow and green);
shiver in hand, weakness;
a significant reduction in the number of heart abbreviations per minute (bradycardia);
the formation of fingertips and nasolabial triangle.

Influence on the gastrointestinal

Give a patient activated carbon and abundant drink

Heart glycosides poisoning in small doses may cause nausea and vomiting. If it was a single excessive reception, then the symptoms of the ailment weakened in a few hours. A day later, a person will feel much better.

Noticing or a close relative, signs of overdose, should calm it, give activated carbon and provide abundant drinking.

Cardiac drugs and nervous system

In case of poisoning, cardiac glycosides arises a serious load on the nervous system. A specific feature is the appearance of color visual hallucinations (the main colors - yellow and green).

Perhaps the occurrence of tremor hands, cramp.

With intoxication, similar substances deteriorates the general state of the person, the confusion of consciousness, dizziness and acute lack of fresh air occurs.

Glycosidic substances and excretory functions

Excess similar substances in the body affect the liver and kidneys. A distinctive feature of the manifestation of these substances in the body can be considered the absence of appetite and a sharp decrease in the urine allocated, up to its complete absence.

Drug overdose: influence on the heart

In overdose, bradycardia occurs

The paradoxical effect of substances is that their excess leads to shopful deterioration those symptoms against which the medicine was used. The victim appears:

weakness, lethargy;
the weakening of heart rhythm, heart failure arises;
failure of cardiac rhythm, which are easily diagnosed on the ECG.

Actions in poisoning

Everyone who has a heart problem, as well as close relatives of these people, you need to know about the first urgent help in overdosing the drugs taken by them. After all, digitalistic intoxication, the treatment of which implies constant control by specialists, may not be reduced to no long regressive period of the disease.

Most often, inpatient treatment is needed, because the ECG in overdose by cardiac glycosides may be required quite often.

What can be done at home

In case of suspicion of poisoning with cardiac drugs, it is necessary to refuse to receive a subsequent dose and take activated coal in accordance with the weight.

It is necessary to rinse the stomach

When the drug is used for a long time and there are suspicions that several tablets have been recovered at once, it is necessary to wash the stomach, drinking a volley several glasses of water and pressing after that at the root of the language.

It is important to ensure good air access and full of peace, unbutton tight clothes and put the victim to bed.

Call Emergency Brigade

Antidot heart glycosides is introduced in a hospital. It may be a drug based on antibodies to digoxin, obtained from sheep serum or chicken protein. In medical practice, several substances are used, with similar properties, but the most efficiently qualified specialist in the hospital can be selected.

At home, emergency brigade will carry out additional stomaching with a special probe. Through an additional tube in the stomach, you can enter a glass of oil to stop the distribution of digoxin by the body.

Depending on the state of the victim and data on the cardiogram, urgent help team analyzes whether this type of care has been effective, and what the following measures are necessary. Thus, they come to a decision on the need for hospitalization.

Heavy poisoning: hospitalization

Antidote injected in the hospital

When inxicating with cardiac glycosides caused by a dose of two times higher than therapeutic, treatment is carried out in a hospital. It is important to remember that, having received more than five times the drug, rather than you need a person can die.

Therefore, the use of these substances by persons who have problems with memory must be carried out under the supervision of relatives. In cases, accidentally overdose, urgent help of specialists is needed.

In a hospital, all available methods use to facilitate the condition of the victim. After the introduction of antidote was carried out, there should be a positive dynamics for an hour. It can be clearly traced under the condition of the use of special cardiac equipment.

If the body has moved well the introduction of antidote, then the consequences and the painful state of the person are corrected.

Since the dihytalic drugs used violate the balance of the necessary trace elements in the heart muscle, additional injections of potassium or magnesium electrolytes may be required.

The occurrence of glucose deficiency is possible, then an elevator with glucose is introduced drip. Such a combination is useful in almost any types of poisoning.

Further treatment is carried out under a clear supervision of specialists who, with the help of laboratory observations, should restore the broke.

Forecast

The positive effect of digital substances on the cardiovascular system is known for a long time. To improve the work of the heart, they were used against latin name Which sounds like "Digitalis".

However, the overdose of this tool could be very dangerous, so in order to have a healthy heart and it is good to feel important to comply with the recommendations prescribed by the doctor.

In the event of deterioration of well-being, you should immediately contact the medical institution, rather than self-defense to appoint additional drugs. Privilely provided medical care will help to avoid further unpleasant consequences.

With the correct actions of the physicians, the human body is able to recover in a few days. After this, the main cardiac treatment will be adjusted.

Digitalization intoxication (heart glycosides poisoning) is a severe complication of the treatment of patients suffering from heart disease and receiving drugs of Digitalis Group (Digoxin).

Manifestations of acute poisoning with heart glycosides do not depend on their ways to enter them into the body.

The clinical picture of digitalistic intoxication consists of several leading syndromes, in particular:

gastrointestinal
cardiovascular
psychoneurological I.
vision disorders.

Emergency Assistance in Digital Incication

a) stop treating cardiac glycosides;
b) introduce unitiol, vitamin E and glycocorticoids to reduce the manifestations of PSKE in the first day - 3-4 times, in the following days - 2-3 times;
c) re-rinse the stomach, introduce salt laxative and activated carbon through the probe to prevent the absorption of poison in the gastrointestinal suction. Also take inside 200 ml of vaseline oil or 8 g of cholestramine, which will ensure the cessation of circulation if the intoxication is caused by dihytoxyin or isolanide;
d) ensure the inhalation of oxygen, infusion 5-10% glucose with insulin, cocarboxylase, vitamin B6 intravenously;
e) normalize the rhythm and conductivity of the heart with anti-erroximal means, with the exception of Novocainamide and Cynidine, which are contraindicated. In the absence of effect - to carry out electrocardialization or defibrillation of the heart;
e) in the presence of vomiting and excitement introduce a parenteral diprage 1 ml of 2.5% solution, promotionalol 1 ml of 1% solution or one of the neuroleptic means (Droperidol - 1-2 ml of 0.25% solution or aminazine - 1-2 millilita 2, 5% solution). As an antiarrhythmic agent to use the polarizing mixture;
e) reducing the effect of endogenous calcium on the contractile function of myocardium due to the disodium salt of ethylenediaminetetraacetic acid 3-4 g of 500 milliliters of 5% of the glucose intravenously drip, 2% solution of sodium citrate 5 ml / kg verapamila 1-2 millilita 0.25% solution or other calcium channel blockers (phenihydine etc.);
g) to normalize myocardial excitability (with arrhythmias, cardiogenic collapse) introduce intravenously drip 10% Tetacin calcium in a 5% glucose solution or isotonic solution of sodium chloride in a single dose of 15-25 mg / kg, in daily - 30-75 mg / kg ;
c) in the presence of hypokalemia to use potassium preparations (Panangin, potassium chloride, potassium and sodium asparaginat).

Antidote when poisoning with cardiac glycosides

For the treatment of acute and chronic heart failure in the Arsenal of Cardiologists medications, selectively act on myocardium. At enough high efficiency According to the activation of the work of the heart muscle and the regulation of heart abbreviations, there is a sufficiently serious problem of similar therapy - the poisoning of cardiac glycosides. The reason for this paradox is wide spectrum pathological conditions suitable for these drugs and their narrow therapeutic range.

The high percentage of intoxication during the reception of this group of drugs lies in the peculiarities of the pharmacological properties of these substances: the maximum effect of cardiac glycosides on myocardium can be obtained only when the appropriate concentration of the drug in blood serum is reached. This process directly depends on the absorption rate of the drug substance, distributing it along the vascular channel and the timely removal from the body with urine. If one of these stages is impaired, inxication of cardiac glycosides can develop.

To occur to such a situation, it is sufficient to simultaneously use to achieve the therapeutic effect of diuretic and digoxin. A decrease in the percentage of potassium in the liquid part of the blood dramatically increases the susceptibility of the patient's body to cardiac glycosides. The same effect occurs in disabilities of the gastrointestinal tract: vomiting and diarrhea can cause poisoning with cardiac glycosides.

It is impossible to exclude the use of heart glycosides with the goal of suicide and random poisoning, for example, when entering some plants in food. Biologists consider dangerous species:

may Lily
oleander yellow and ordinary
squill,
natrestyanka.

Such poisoning belongs to the category of severe intoxication. They can end tragically and require emergency response.

If the patient is recommended to simultaneous use of the antibiotics of the group of macrolides and derivatives of the valley and ingredients, the likelihood of poisoning is extremely high. The thing is that antibiotics depress the removal of heart glycosides from the body of the patient than contribute to the excessive accumulation of digoxin or stanfantine in the tissues.

A big role in the development of sharp or chronic poisoning with heart glycosides can play the age of the patient, simultaneous receiving these drugs with other medicinal substances and scattered during treatment.

Major clinical symptoms in the patient

It should be understood that the mechanism of pathological disorders in the human body with sharp and chronic poisoning is quite different, therefore the symptoms of these processes will be different.

Chronic poisoning with drugs and lily of the valley usually proceeds somewhat differently. Neurological symptoms can accumulate for a long time, in addition, and the age of the patient often prevents the correct diagnosis.

Violations in the work of the GCC also arise gradually, as glycosides accumulates in the patient's blood plasma. Basically, patients have nausea and stool disorder.

Heart from the heart, the first sign of chronic poisoning is most often arrhythmias with a low heart rate. The main difference of this state from the acute process is the almost complete absence of the reactions of the heart muscle to the introduction. The emergence of tachyarhythmias, the center of the occurrence of which will be the ventricles of the heart.

The diagnosis of chronic poisoning with heart glycosides is also often difficult due to the womb of symptoms. Even the determination in the blood plasma of the elevated digoxin concentration may indicate not only the overdose of the drug, but also on the slow motion exchange processes in the tissues. This condition is usually found in patients with renal and liver failure, pregnant women, sharply weakened patients.

For differential diagnosis Chronic intoxication necessarily determine the presence of free digoxin in the blood.

First aid for poisoning by drugs and valley

If the patient is assumed to be acute cordial glycosides, then the holding of emergency measures will help save person. However, in providing first aid of such a category of patients there are certain difficulties.

For any poisoning, it is necessary to prevent the poisoning substance in the blood. To do this, wash the stomach and put the victim of the enema. However, in the case of cordial poisoning, such a technique is ineffective.

Due to its pharmacological activity, these drugs are not delayed in the stomach, to wash them out is not possible, but many experts recommend using activated carbon in large doses. There are scientific work, proving the ability of the maximum amount of activated carbon to reduce the percentage concentration of digoxin and stanfantine in blood plasma.

Timely appeal to specialized help It will help to avoid many complications. And, of course, the cessation of receiving any glycoside-containing drugs. In the development of tachyarhythmias, it is possible to offer patient atropine to reduce the contractile function of myocardium.

Specialized treatment with poisoning with heart glycosides

When conducting specific therapy of such states, antidote of cardiac glycosides is injected with a patient. In the list of drugs of a specialized ambulance brigade, there is an antidigoxine preparation. Its use in the overdose of the derivatives of the dimensions is approved by an emergency algorithm for acute poisoning.

The negative side of this medicine is its high price. However, in calculating costs for treatment under the Food conditions and conducting repeated laboratory tests on free digoxin, the benefit of its application becomes obvious.

In addition to antidote therapy, there is an emergency relieving possible full blockade Av-node and bradyarithmias emerging from various parts of the heart. For this, the administration of atropine is used to 1 mg / kg of weight, phenytoin and lidocaine in standard dosages. Timely application of antidote can exclude the reception of these drugs in the acute period of poisoning.

To treat such states, it is very important to normalize the water-electrolyte balance in the patient. First of all, you need to stabilize potassium in the blood. To reduce the concentration of the trace element at home, insulin can be used, 40% glucose solution, and in their absence and the usual soda.

Specialists are not recommended for similar states to include calcium chloride and calcium gluconate. These drugs are good in the case of chronic poisoning, with an acute process, their use is threatened by the overexcixation of the conductive heart system.

Prior to the introduction into the practice of resuscitation brigades of antidigoxin, the main antidote in poisoning with cardiac glycosides was considered magnesium sulfate. This drug stabilized the level of potassium in plasma and prevented the occurrence of extrasystole. Currently, many doctors relate to magnesium sulphate with a certain prejudice.

In addition to drugsAt the disposal of cardiologists and resuscitors there are other ways to restore cardiac rhythm during glycosides poisoning. To remove the border of bradycardia, cardiologists use the external electrical pacemaker method. A more serious card reader is recommended to use in the threatening life of rhythm disorders.

During the treatment of acute poisoning with cardiac glycosides, the main efferent methods of hemosorption and hemodialysis practically do not apply. This is associated with the rapid penetration of glycosides in the blood plasma and the speed of their propagation in the body.

The consequences of the transferred state

If the help arrived on time, and the threat of catastrophic violations of the activity of the heart is not, the patient is in the hospital 5 - 7 days. In this period of time, it constantly passes the ECG control, it is possible to conduct an ultrasound of the heart in order to identify pathology in the muscular wall.

Laboratory tests are also included in the necessary list of surveys after poisoning with cardiac glycosides. To extract the patient from the hospital, it is necessary that the potassium level in the blood plasma is stable for 3 to 4 days, and the presence of digoxin did not exceed 1n / ml.

There are no certain standards of behavior after such stress. It all depends on the age of the patient, the severity of its heart pathology, ordinary physical Loads etc. The only exceptions are people who used the drugs of Lily of Lily and on the aim of suicide. A similar contingent after extracting from the hospital necessarily undergoes a survey and treatment with a psychiatrist.

Cardiac glycosides, like most cardiac drugs, in overdose can cause irrenectible damage to health and even lead to death. When used in the treatment of similar drugs, it is necessary to relate to their technique and alert. Treatment of poisoning with cardiac glycosides is a complex and expensive process. It is desirable that most patients remember this.

First emergency assistance in poisoning with cardiac glycosides, symptoms and treatment.

Signs of poisoning with cardiac glycosides appear when the minimum therapeutic dose is exceeded by 2 times. Given the individual sensitivity of patients to drugs, the risk of overdose of heart glycosides is great. Exceeding the minimum therapeutic dose of cardiac glycosides is 5-10 times deadly.

Most often, such glycoside as Digoxin is prescribed to treat heart disease. Its suction and distribution over tissues in the body occurs slowly, it gradually accumulates in muscle tissue and liver. With violations of the kidney and liver functions, its excretion from the body is even more slow and the likelihood of poisoning increases. Therefore, cardiac glycosides are prescribed only under the control of the doctor and in the treatment process corrected their doses. Patients with overdose of heart glycosides or poisoning them need emergency care.

Symptoms of poisoning with cardiac glycosides.

In case of poisoning, heart glycosides appears vomiting, consciousness (confusion) is disturbed, then it is lost, seizures can be. Acquisition of visual disorders are developing - the vagueness of visible objects, a violation of color perception, fear of light, loss of fields. Toxic damage to the heart is manifested by the rhythm of the rhythm of its abbreviations, the reduction in frequency, the atria ventricular blockades. In acute poisoning, on the contrary, the increase in cardiac rhythm, a decrease in blood potassium levels.

Emergency care for poisoning with cardiac glycosides.

With cordial glycosides poisoning, these drugs are canceled. Do not cause vomiting or give vomit tools, as this may adversely affect cardiac activity. It is necessary to rinse the stomach through the probe. Activated activated carbon and salt laxative means (15-30 g sodium sulfate). Activated coal is given in the future, it helps to withdraw heart glycosides, not only in the intestines, but also contained in the blood.

5% solution of unitiola (5 ml 4 times a day) and a 30% acepherol solution of acetate (vitamin E) is 2 ml per day. Glucocorticosteroid drugs use hydrocortisone (intramuscularly administered 125 mg 3 times a day). If a frequent pulse is observed against the background of poisoning, such drugs are introduced as a 20-25% solution of sulfate magnesium, a solution of lidocaine (1-3 mg / kg of body weight), phenytoin (according to the scheme).

When the pulse is demolished, 1 ml of 0.1% of the sulfate atropine solution is subcutaneously introduced. In this case, it is possible to use isoprenaline hydrochloride intravenously (0.05-2 μg / kg of body weight per minute), antiDigoxin. Last Preparation Enter intravenously slowly for 30 minutes, when stopping the cardiac activity - inkjano. For neutralization of 0.6 mg of digoxin, 40 mg of antidigoxin is required.

For clear arrhythmia (Very frequent ineffective heart reduction) intravenously introduced 5 ml of a 10% solution of the novocainamide. Infusion therapy in the mode of forced diuresis and hemodialysis is ineffective in poisoning with cardiac glycosides. Hemosorption can give a positive result.

Poisoning by opiates, substances and drugs of narcotic action.

Opiatrics include substances and drugs drugs obtained from opium (morphine, heroin, codeine, commander and others). In the overdose of these substances, braking the work of the cerebral cortex, the oppression of the respiratory and cough centers, the excitation of the vomit cerebral center are occurring.

Symptoms of poisoning opiates, substances and drugs of narcotic action.

First develops deep dreamwhich gradually goes into. There is a lack of consciousness and pain sensitivity. Expressed a symbol of skin, sweating. The body temperature is reduced. Breathing becomes superficial, then neulty. Pulse penetrates. Arterial pressure Reduced. Often develops swelling of the lungs. Pupils are strongly narrowed, have appearance points, do not react to light.

First urgent assistance in poisoning by opiates, substances and drugs of narcotic action.

You need to turn the head of the victim to prevent the content of the contents of the stomach in airways. Provide fresh air access. Urgently call "ambulance medical care." If necessary, carry out events. The doctor introduces the breathing tube in the trachea and the stomach probe. Then the stomach is thoroughly washed, better than a weak (1: 2000) solution of potassium mangartage, and 100-150 ml of 33% solution of magnesium sulfate is injected into the stomach. After that, diuretics are introduced (furosemid).

All victims make inhalation with moistened oxygen, sodium hydrocarbonate solution intravenously introduced. In the poisoning of opiates intravenously, intramuscularly or subcutaneously introduces antagonists - naloxone hydrochloride or nipper hydrochloride. The initial dose for adults is 400 μg, for children - 5-10 μg / kg body weight. After 3-5 minutes, the drug is introduced again.

Based on the book "Fast assistance in emergency situations."
Kashin S.P.

Cardiac (including cyanogenic) glycosides are medicinal preparations of vegetable origin, which have therapeutic effects and toxicity at the same time. In case of overdose, digitalistic intoxication of cardiac glycosides may occur.

Digitalization intoxication occurs during the transduction reception of "digitalis" - preparations included in the Heart Drug Administration. They are prescribed in the treatment of chronic rhythm disorders, heart failure. Digitalis, Digitoxine, Digoxin are produced from the components of the plant of aphristic.

Reception of drugs can cause poisoning if there are health status:

elderly age;
disorders of the thyroid gland;
diseases of withdrawing organs - liver and kidney;
blood mineral imbalances (potassium lack, excess calcium) after receiving diuretics;
hypoxia (lack of oxygen) caused by acute cardiac, respiratory failure;
post-infarction state, transferred operations on the heart, any pathology.

A feature of treatment with cardiac glycosides is their long circulation in the blood. Digital drugs provoke increased reduction in abbreviations, an imbalance occurs in the heart of the heart. Glycosidic intoxication occurs, especially if there are problems with the kidneys, liver.

Symptoms of glycosidic intoxication

The manifestation of symptoms depends on the degree of poisoning, can be of different intensity. Signs of poisoning:

Cardial symptoms: sharp angina - squeezing, burning pain in the heart area, passing without receiving medicines in 10-15 minutes. Arrhythmia arises, the obvious feeling of heart work interruptions.
Failures in the work of the digestive system: abdominal pain, lack of appetite, diarrhea, vomiting, nausea.
Headaches, migraine, anxiety, drowsiness, apathy.
The appearance of "flies" in the eyes, lowering the level of view up to blindness.
Strong decrease in blood pressure.
Heavy signs of severe glycoside intoxication: epileptic cramps, including unconscious; Strong defeat of the central nervous system, in charge of a fatal outcome.

Inxication in hard form causes instant cessation of the heart.

During long-term treatment with digitalistic drugs, patients periodically take blood test, which shows the concentration of cardiac glycosides in the plasma.

With cardiac symptoms, digitalis poisoning, digoxin is diagnosed after the electrocardiogram. It is especially important to assign an ECG at the early stage of intoxication, glycosides poisoning can be chronic or acute.

Symptoms of chronic intoxication differs from acute poisoning by less intensity, complexity of detection. The study of electrocardiography should show what the cardiological mechanism of the effect of digoxin at certain parts of the heart.

Emergency Rules

The sharper is the signs of poisoning, the harder the degree of intoxication of the patient whose condition can deteriorate with each minute. In such cases required emergency help, Application of antids and antidotes. If there are signs of overdose, you must urgently cause ambulanceWhile the expectation of which can be assisted at home:

urgent cessation of glycosides, in light cases of poisoning - dose reduction;
challenge vomiting after a large amount of water drilled;
the removal of toxins by using saline solutions, receiving activated carbon, other adsorbents. Washers of the gastrointestinal tract are produced in extreme cases under medical control;
carry out a sick with warm sweet drink, put in a ventilated room;
with an unconscious state, turn the head of the sick side so that it will not suffocate the vomit's masses.

The first medical care to eliminate the effects of cordial glycosides poisoning includes measures:

Multiple conducting ECG for accurate diagnostics of the patient state, severity, recovery after an overdose.
Use of potassium, magnesium preparations, with heavy conditions - intravenous.
After identifying the appearance of arrhythmia - anticircraft drugs are prescribed.
The appointment of special antidotes, the dose of which is appointed by the doctor.
Electrocardiosulation of the heart in emergency cases.

In severe poisoning, hemodialysis is carried out - a special procedure cleansing blood from toxins using an artificial kidney apparatus.

Ensuring peace of peace and careful observation.

Use of antidota

According to the international classification of diseases (ICD), the poisoning of cardiac glycosides is classified under the cipher T 46.0.

To eliminate the consequences of acute intoxication, the patient is prescribed antidote of cardiac glycosides. Therapy is to be binding to the blood plasma of free digoxin, termination of its effect on cardiology cells.

Antidot - fragments of special, specific antibodies running against Digitalis, which are formed in the body of sheep. Studying the pathogenesis of intoxication, scientists concluded that these antibodies are related to digoxin molecules. There are compounds on the molecular level with a protein and gradual withdrawal from the body.

Due to the risk of occurrence allergic reaction, Caution is prescribed digital antidote people who do not carry protein: chicken or sheep.

Prescribed an antidote in a dose proportional to the dose of the diigitalis glycoside. In the instructions for the antidotide there is a dosage calculation formula. DiGitalis antagonists are most well known: diphenin, digibine, unitiol, Digitalis antidote BM.

Review of funds used for intoxicating cardiac glycosides

While the patient is in the clinic to eliminate the consequences of overdose by heart glycosides, it is individually prescribed by drugs restoring the body. Treatment depends on many factors: age, the timing of the use of drugs, the functioning of the liver, kidneys, the presence of chronic diseases.

In mandatory after the adoption of the antidote (the purpose of the antidote depends on the severity of intoxication), toxins are removed by adsorbents: activated carbon, enterosgel, sorbek. Among other means appointed by poisoning may be:

to eliminate hypokalemia, potassium replenishment in cardio organs, against dehydration - potassium chloride, insulin, glucose, Panangin, Potassium orotat, asparks;
in bradycardia (slowed down pulse), vomiting, nausea - atropine, increasing cardiac abbreviations. It must be borne in mind that atropine is contraindicated in tachycardia, as well as the use of adrenaline (in order to avoid fibrillation of cardiac ventricles);
the drug is magnesium sulfate, provided that there are no violations in the work of the kidneys;
for the formation and removal of calcium compounds, violates the vessels - trilon b, citrate salts;
for termination of arrhythmia - propranolol, lidocaine, anaprilin, Novocainoid. Eliminates ventricular arrhythmias phenytoin;
if necessary, appointed anticonvulsant agents Aminosine, sodium oxybutirate, Sibaz;
conduct oxygen therapy, eliminating oxygen starvation of organs;
prescribed vitaminotherapy with vitamin E, group B, to maintain the work of the riboxin cardiovascular system, aspicard.

Possible complications and prevention

Heart glycosides in the treatment of violations of the heart are successfully used in the treatment of heart failure. The main recommendations are the conduct of ECG, control of potassium level, observation by specialists. The benefits of treating Digitalis repeatedly exceeds the risks of poisoning. With proper reception, the risk of intoxication is about 5%. Preparations are prescribed even pregnant women, nursing women under the supervision of the child's condition and mother.

Main preventive measure Possible poisoning of cardiac glycosides is to comply with the dosage of drugs of vintage. The deadlines for the use of glycosides are important, due to their ability to accumulate.

During the reception, careful observation of well-being needed. It is necessary to use products containing potassium: Kuragu, dates, raisins, young potatoes.

When the symptoms of poisoning are found - urgently apply for medical attention.