Hansteen V, Jacobsen D, Knudsen K, Reikvam A, Skuterud B
Clin Toxicol. 1981 Jun;18(6):679-92. doi: 10.3109/15563658108990294.
Severe digitoxin poisoning in seven patients is reported. Doses taken varied from 2 to 20 mg, and maximal plasma concentrations of digitoxin from 50 to 237 nmol/L. One patient died from ventricular fibrillation, and the course in another was considerably protracted due to severe complications. The course in all patients was more dependent on underlying heart disease than on the plasma digitoxin concentration. Based on our own experiences and survey of the literature the following treatment is proposed: Gastric aspiration and lavage followed by instillation of activated charcoal should even be performed many hours after drug intake. In order to interrupt the enterohepatic circulation of digitoxin, repeated doses of charcoal should be given. Charcoal is preferable to cholestyramine because of its better tolerability. Ventricular arrhythmias should not be treated unless they are serious, because most antiarrhythmic drugs may further impede the AV-conduction. Phenytoin is the drug of choice, because the AV-conduction is less affected or even improved, and because the metabolism of digitoxin is accelerated. Conduction disturbances with bradycardia are frequently seen and may occur suddenly. Prophylactic introduction of a transvenous pacing catheter is therefore recommended as a routine procedure.
报告了7例严重洋地黄毒苷中毒患者。服用剂量从2毫克至20毫克不等，洋地黄毒苷的血浆最大浓度为50至237纳摩尔/升。1例患者死于心室颤动，另1例患者因严重并发症病程显著延长。所有患者的病程更多地取决于基础心脏病，而非血浆洋地黄毒苷浓度。根据我们自己的经验和文献调查，建议采用以下治疗方法：即使在服药数小时后，也应进行洗胃和灌洗，随后注入活性炭。为了阻断洋地黄毒苷的肠肝循环，应重复给予活性炭。由于活性炭耐受性更好，因此比考来烯胺更可取。除非室性心律失常严重，否则不应进行治疗，因为大多数抗心律失常药物可能会进一步妨碍房室传导。苯妥英是首选药物，因为它对房室传导的影响较小甚至会改善，而且洋地黄毒苷的代谢会加快。常可见伴有心动过缓的传导障碍，且可能突然发生。因此，建议常规预防性置入经静脉起搏导管。
