Delgado Jiménez J F, Casillas Villamor A, Gómez Pajuelo C, Sáenz de la Calzada C
Servicio de Cardiología, Hospital Doce de Octubre, Madrid.
Rev Clin Esp. 1991 Nov;189(8):374-6.
A case report of severe digitalis poisoning in a patient with prosthetic heart valve is presented. He complained of nausea, vomiting, drowsiness, temporal disorientation and lethargy. The electrocardiogram showed idioventricular rhythm, and plasma levels of digoxin were 6.78 ng/ml. Predisposing factors por digitalis poisoning were prerenal failure and concomitant quinidine therapy. Treatment with digoxin-immune antibody fragments (FAB) promptly lead to abolition of the ventricular arrhythmia and disappearance of every clinical symptoms in hours. Plasma digoxin levels showed a steep decrease until normal values at the fifth day. The favourable course of either clinical and electrocardiographic response to IV administration of FAB are discussed, stressing the fact of the high morbidity of digitalis poisoning in opposition to the relative safety of Fabs use in its therapy.
本文报告了一例人工心脏瓣膜患者发生严重洋地黄中毒的病例。患者主诉恶心、呕吐、嗜睡、时间定向障碍和乏力。心电图显示室性自主心律,地高辛血浆浓度为6.78 ng/ml。洋地黄中毒的诱发因素为肾前性肾衰竭和同时使用奎尼丁治疗。使用地高辛免疫抗体片段(FAB)治疗后数小时内迅速消除了室性心律失常,所有临床症状均消失。血浆地高辛浓度急剧下降,直至第五天恢复正常。讨论了静脉注射FAB后临床和心电图反应的良好过程,强调了洋地黄中毒高发病率这一事实,以及与之相对的FAB治疗的相对安全性。