![]() Urinalysis revealed trace urine protein and specific gravity of 1.020. Electrocardiogram revealed intermittent runs of supraventricular tachycardia. During this time, he had over 10 episodes of diarrhea, and became slightly confused, and moderately diaphoretic. The next day, he developed a feeling of “pins and needles” in the lower extremities, followed by pain, burning sensations, and weakness in both upper and lower distal extremities over the next 12 hours. He had clinical signs of dehydration and laboratory evidence of fluid depletion and was admitted overnight for treatment of dehydration. Case presentationĪ 26-year-old man developed nausea, abdominal cramping, and mildly bloody diarrhea, 9 hours after a suicidal ingestion of illegally imported rat poison. Thallium is a well-known poison cited in numerous works of fictional literature, but is also a popular real-life agent of murder with worldwide homicidal usage documented since the 1800s. Thallium is a tasteless, odorless, and extremely potent poison – acute ingestions of as little as one gram of thallium salt may kill an adult. Today, medicinal use is limited to trace amounts of radioactive thallium for nuclear imaging. Thallium is a metal with a storied history of medicinal and commercial applications as a depilatory, syphilis remedy, rodenticide, ant killer, and in the manufacturing of photocells and semiconductors. American Journal of Medicine, 125 (4), 337-343.Thallium was accidentally discovered in 1861 by Sir William Crookes, who noted an unexpected green banding on colorimetric spectroscopy, while researching tellurium ore (Greek, thallos: “green young shoot”). Digitalis toxicity: A fading but crucial complication to recognize. Haddad and Winchester's clinical management of poisoning and drug overdose (Fourth ed.). American Journal of Cardiovascular Drugs, 11 (3), 173-178. Prognostic utility of serum potassium in chronic digoxin toxicity: A case-control study. Goldfrank's toxicologic emergencies (Tenth ed.). American Journal of Cardiovascular Drugs, 6 (2), 77-86.īTG International Incorporation. ![]() Mechanisms, manifestations, and management of digoxin toxicity in the modern era. Quebec, Canada: Centre antipoison du Quebec.īauman, J. Antidotes en toxicologie d'urgence (3rd ed.). Partial treatment is acceptable if full amount is not available. Contact nearest Emergency Department for additional stock if needed.īailey, B., Blais, R., Gaudreault, P., Gosselin, S., & Laliberte, M. (2009).One 40 mg vial of DigiFab ® will neutralize approximately 0.5 mg (500 microgram) of digoxin. Dose varies according to the amount of digoxin to be neutralized.THERAPEUTIC ENDPOINT: Adequate clinical response (stable EKG and vital signs). Improvement in signs and symptoms of digoxin toxicity typically begins within one half hour or less following digoxin immune Fab administration.Digoxin level to be drawn BEFORE administration of antidote only.Blood pressure and cardiac monitoring and monitoring of potassium levels required. Intermittent Infusion: Dilute dose in 100 mL sodium chloride 0.9% and administer over 30 minutes.Blood pressure monitoring, cardiac monitoring and monitoring of potassium levels required. IV Direct: If cardiac arrest is imminent, may administer dose undiluted.Reconstitution: Reconstitute each vial with 4 mL sterile water for a final concentration of 10 mg/mL DigiFab®.continued toxicity such as arrhythmias, unstable vital signs).Īdminister one vial at a time over 30 minutes by IV infusion. After discussion with the poison centre, additional doses of Digoxin Immune Fab may be given if response was inadequate (i.e. Serum levels done prior to 6 hours can still be used to calculate dose but may overestimate the dose required.Īdditional Dosing: For hours to days AFTER Digoxin Immune Fab is given, digoxin levels are clinically meaningless and should NOT guide decisions around further antidote treatment, as they can be falsely elevated. Serum concentration (nmol/L) x 0.781 x patient weight (kg)ĭigoxin levels done greater than 6 hours post dose more accurately reflect toxicity. *Note: Round up to the next highest number of vials. ![]() Repeat if needed for ongoing toxicity.Īmount Ingested Unknown: Dose (in vials)* = With hemodynamic compromise: Give 2-4 vials over 30 minutes by IV infusion. ![]() If full amount not available, give closest amount available. Cardiac arrest imminent or present: 10 vials by direct IV, repeat 5 - 10 vials as needed for ongoing toxicity, after 3 - 5 min.Acute or chronic life-threatening digoxin toxicity (or other cardioactive steroid: digitoxin, plants, toad venom): tachy or brady-arrhythmias, hypotension, hyperkalemia (greater than 5 mEq/L) and/or a digoxin serum level of greater than 12.8 nmol/L (greater than 10 ng/mL).Įmpiric Dosing (Unknown level and severe toxicity):. ![]() ALERT: This item is found in the refrigerator antidote kit. ![]()
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