| Acute digitalis intoxication--is pacing still appropriate? | |
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MedLine Citation:
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PMID: 8492339 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Over a six year period, 92 patients intoxicated with either digitoxin or digoxin were admitted to our ICU. Fifty-one patients were treated with cardiac pacing and/or Fab fragments, and the mortality rate was 13% (14 were intoxications with digoxin, 36 with digitoxin, 1 was mixed). Forty-five cases were suicide attempts; six were accidental overdosages. Since cardiac pacing may trigger fatal arrhythmia or delay the administration of Fab fragments, we conducted a retrospective study to determine whether fatal outcomes could be related either to cardiac pacing or to unsatisfactory use of immunotherapy. In our study, prevention of life-threatening arrhythmia failed in 8% of cases with Fab and in 23% with pacing. Though Fab tended to be more effective, this difference was not significant. In our study, the main obstacles to the success of Fab were pacing-induced arrhythmias and delayed or insufficient administration of Fab. Iatrogenic accidents of cardiac pacing were frequent (14/39, 36%) and often fatal (5/39, 13%). In contrast, immunotherapy was not associated with any serious adverse effects (0/28, 0%) and was safer than cardiac pacing (p < 0.05). In conclusion, during digitalis intoxication, the pacemaker has limited preventive and curative effects, is difficult to handle, and exposes patients to severe iatrogenic accidents. Fab fragments act as a powerful antidote and are safer and much easier to use than pacing. These results encourage us to prescribe Fab fragments as first-line therapy during acute digitalis intoxication. |
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Authors:
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P Taboulet; F J Baud; C Bismuth; E Vicaut |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of toxicology. Clinical toxicology Volume: 31 ISSN: 0731-3810 ISO Abbreviation: J. Toxicol. Clin. Toxicol. Publication Date: 1993 |
Date Detail:
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Created Date: 1993-06-17 Completed Date: 1993-06-17 Revised Date: 2005-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8213460 Medline TA: J Toxicol Clin Toxicol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 261-73 Citation Subset: AIM; IM |
Affiliation:
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Hopital Fernand Widal, Université Paris VII, France. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Cardiac Pacing, Artificial* Cause of Death Digitalis Glycosides / poisoning* Female Gastric Lavage Humans Immunoglobulin Fab Fragments / therapeutic use* Intensive Care Units Male Middle Aged Overdose Retrospective Studies Suicide, Attempted |
| Chemical | |
Reg. No./Substance:
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0/Digitalis Glycosides; 0/Immunoglobulin Fab Fragments |
| Comments/Corrections | |
Comment In:
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J Toxicol Clin Toxicol. 1993;31(2):275-6
[PMID:
8492340
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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