Van Deusen Shawn K, Birkhahn Robert H, Gaeta Theodore J
Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, New York 11215, USA.
J Toxicol Clin Toxicol. 2003;41(4):373-6. doi: 10.1081/clt-120022006.
Cardiac glycoside toxicity is frequently associated with hyperkalemia and dysrhythmias in patients with renal insufficiency. Two common therapeutic options for these complications (calcium and transvenous cardiac pacing) are considered contraindicated in the setting of cardiac glycoside toxicity. We present the case of a patient presenting with a pronounced bradydysrhythmia and hyperkalemia who was treated with intravenous calcium and transvenous cardiac pacing and later found to have digitalis toxicity and acute renal failure. There were no adverse events associated with the therapies. The patient received digoxin-specific Fab fragments and hemodialysis as definitive therapeutic modalities. The case and the relevant literature evaluating the interaction of calcium salts and cardiac pacing in the setting of cardiac glycoside toxicity are discussed.
在肾功能不全患者中，强心苷毒性常与高钾血症和心律失常相关。对于这些并发症的两种常见治疗选择（钙剂和经静脉心脏起搏），在强心苷毒性情况下被视为禁忌。我们报告一例患者，该患者表现为明显的缓慢性心律失常和高钾血症，接受了静脉补钙和经静脉心脏起搏治疗，后来发现患有洋地黄中毒和急性肾衰竭。治疗过程中未出现不良事件。该患者接受了地高辛特异性Fab片段和血液透析作为确定性治疗方式。本文讨论了该病例以及评估在强心苷毒性情况下钙盐与心脏起搏相互作用的相关文献。
