Levine Michael, Nikkanen Heikki, Pallin Daniel J
Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ, USA.
J Emerg Med. 2011 Jan;40(1):41-6. doi: 10.1016/j.jemermed.2008.09.027. Epub 2009 Feb 6.
Digoxin is an inhibitor of the sodium-potassium ATPase. In overdose, hyperkalemia is common. Although hyperkalemia is often treated with intravenous calcium, it is traditionally contraindicated in digoxin toxicity.
To analyze records from patients treated with intravenous calcium while digoxin-toxic.
We reviewed the charts of all adult patients diagnosed with digoxin toxicity in a large teaching hospital over 17.5 years. The main outcome measures were frequency of life-threatening dysrhythmia within 1 h of calcium administration, and mortality rate in patients who did vs. patients who did not receive intravenous calcium. We use multivariate logistic regression to ensure that no relationship was overlooked due to negative confounders (controlling for age, creatinine, systolic blood pressure, peak serum potassium, time of development of digoxin toxicity, and digoxin concentration).
We identified 161 patients diagnosed with digoxin toxicity, and were able to retrieve 159 records. Of these, 23 patients received calcium. No life-threatening dysrhythmias occurred within 1 h of calcium administration. Mortality was similar among those who did not receive calcium (27/136, 20%) compared to those who did (5/23, 22%). In the multivariate analysis, calcium was non-significantly associated with decreased odds of death (odds ratio 0.76; 95% confidence interval [CI] 0.24-2.5). Each 1 mEq/L rise in serum potassium concentration was associated with an increased mortality odds ratio of 1.5 (95% CI 1.0-2.3).
Among digoxin-intoxicated humans, intravenous calcium does not seem to cause malignant dysrhythmias or increase mortality. We found no support for the historical belief that calcium administration is contraindicated in digoxin-toxic patients.
地高辛是钠钾ATP酶的抑制剂。过量服用时，高钾血症很常见。虽然高钾血症通常用静脉注射钙剂治疗，但传统上在洋地黄中毒时是禁忌的。
分析地高辛中毒患者接受静脉注射钙剂治疗的记录。
我们回顾了一家大型教学医院17.5年内所有诊断为地高辛中毒的成年患者的病历。主要观察指标为钙剂给药后1小时内危及生命的心律失常发生率，以及接受与未接受静脉注射钙剂患者的死亡率。我们使用多变量逻辑回归来确保没有因负性混杂因素而忽略任何关系（控制年龄、肌酐、收缩压、血清钾峰值、地高辛中毒发生时间和地高辛浓度）。
我们确定了161例诊断为地高辛中毒的患者，并能够检索到159份记录。其中，23例患者接受了钙剂治疗。钙剂给药后1小时内未发生危及生命的心律失常。未接受钙剂治疗的患者死亡率（27/136，20%）与接受钙剂治疗的患者（5/23，22%）相似。在多变量分析中，钙剂与死亡几率降低无显著相关性（优势比0.76；95%置信区间[CI]0.24 - 2.5）。血清钾浓度每升高1 mEq/L，死亡优势比增加1.5（95% CI 1.0 - 2.3）。
在地高辛中毒的人群中，静脉注射钙剂似乎不会引起恶性心律失常或增加死亡率。我们没有找到支持地高辛中毒患者禁忌使用钙剂这一传统观念的依据。
