*For medical professionals for reference
Gaoxin, you have to know!
Writing | Sui Feng
Gaoxin is a commonly used drug in Cardiology, mainly used in light median degreesHeart failure, control the ventricular rate of atrial fibrillation (AF) and atrial flutter (AFL) with a fast ventricular rate.Di Gaoxin has a narrow treatment window and large individual differences [1], and the upper limit of the effective treatment concentration is 2 μg/L. The risk of toxic reactions in drug users is high.
Recently, I received a medication consultation.
Patients confirmed the coronary atherosclerotic heart disease, heart failure, more than 30 years, long -term oral segemid tablets [20mg once a day (QD)], snailin tablets (20mg QD)Amber acid Metolol Smoil (47.5mg QD) for disease control.
2 weeks ago, the patient took the doctors advice to take the Gaoxin tablet (0.25mg QD). One week after taking the medicine, the patient had gastrointestinal symptoms such as nausea, vomiting, and the symptoms increased day by day by day.EssencePatients have denied the history of the digestive system, considering that the patient has recently served Gaoxin, and it does not rule out the possibility of high poisoning of the earth.Then it is recommended that patients immediately measure the concentration of high blood drugs, electrolyte levels, etc.; If the measurement results are abnormal, they need to be referred to Cardiology
It can be seen that clinically the case of high -poisoning of Gaoxin is not rare.So, how should the clinical case of high poisoning?
Symptoms of Gaoxin Poisoning
The clinical manifestation of Gaoxin poisoning:
Gastrointestinal tract: nausea, vomiting, loss of appetite;
Visual: Visual vision, color sense abnormal (color sensation (colorfulness (color sensory abnormalities (colorful sensation (color sense abnormalities (colorfulness (colorfulness (color sensory abnormalYellow -green);
Nerves: dizziness, fatigue, drowsiness;
Heart: Slow heart, room conduction block, ventricular premature beats, and ventricular heart tachycardia; ECG (ECG) can be manifested as ST section ("spoon -shaped shape""Or" inverted "), T wave flat or inverted.
High -risk crowd who pays attention to Gaoxin poisoning,
Measure the concentration of blood medicine
If you have high land, if you accompanied by incomplete kidney or electrolyte disorders (low potassium, low magnesium low magnesium, low magnesium, low magnesium, Hyplavicores) [2], dehydration, combined medication (such as a joint diuretic, β -blocker, etc.), the risk of high poisoning in the area of high -pellets has increased significantly.Patients mentioned earlier, combined with cymbal rice, screw, and high -level, Due to the interaction between drugs, the concentration of the high -gallophyte blood drugs increased, and the gastrointestinal toxic response occurred. Cycusami is potassium excretion and diuretic drugs. Under low potassium state, the sensitivity of myocyte cells to the ground is increased; while the snails are eliminated by high scholarship, and the concentration of blood drugs has increased, increasing the risk of high poisoning of the earth,[3].
Therefore, clinically focusing on high -risk people who have high toxic reactions in the place where high -toxic reactions occur.The amount of high Xin; reduces the incidence of toxic reactions as much as possible.Di Gaoxin needs to be 6-8h in human tissue. In order to accurately determine its blood concentration as possible, it is recommended that the sampling time point should be given 6h at the last time.
Clinical intervention
1. Should not be used to use hemodialysis, because dialysis cannot effectively eliminate high -body in the body; Time to stop medicine is the key.For acute high -poisoning, oral or nasal and gastric tubes can be given activated carbon to promote the excretion of residual drugs.
2. closely observe the clinical manifestations of patients after stopping the drug, settling ECG monitoring, follow -up of blood drug concentration and electrolyte; improve the 24h dynamic ECG when necessary.
3. Correct electrolyte disorders.If hypokalemia appears, timely potassium is supplemented to keep blood potassium at 4.0-5.5mmol/L.
4. Intervention of arrhythmia.For ventricular fast arrhythmia, can be used to use Lida -cackin; those with chronic arrhythmias use Atto; some cases may need to install a pacemaker after being evaluated by the cardiac expert.
5. Individualization gives anti -ground high -psiae Fab fragments.Anti-ground Gaoxin FAB fragments are effective and fast, which can relieve the clinical symptoms of 50%-90%of the cases of Gaoxin poisoning [4]. After 30-45min, the patients poisoning symptoms are significantly reduced.
When the local high -pellet poisoning person is accompanied by the risk of life such as cardiac arrest, such as a ventricular tachycardia, a heart -fighting or a height atrioventricular block, serum potassium, potassium& gt; 6.5 mmol/L. In low blood pressure related to the end -end organ dysfunction, it is recommended to use 5 bottles (40mg/bottle) of the anti -ground high -psiae FAB fragment.].In addition, those who have a significant increase in high blood drugs in the body in the body can consider the use of anti-ground high-psiae FAB fragments (40-80 mg), and additional addition of clinical symptoms of patients.
Due to the differences in age, basic diseases, kidney skills, etc. due to the people used, some scholars believe that initially give the 40-120 mg anti-ground Gaoxin FAB fragments to get the detoxification effect [4].Therefore, the dosage of anti -ground high -psionic FAB fragments shall be individualized, and the serum electrolyte, body temperature, blood pressure, ECG, and kidney skills shall be monitored during treatment.
Reasonable use of Di Gaoxin
Small doses began to administer, and adult patients give 0.125-0.25mg/d high-scholarship. After 1 week of medication, the concentration of steady-state blood drugs is reached;].
During the period of Xin, gastrointestinal reactions or visual abnormalities, suspended administration, and timely check the concentration of high Xinxin blood drugs in a timely manner; and specify the next step intervention plan according to the drug concentration value.
Gao Xins course of treatment is long, and his blood concentration is required during the medication.It is recommended that patients with TDM 1-2 weeks after taking the medicine, and reviewed every 1 to March.
Monitoring heart rate during treatment (Including exercise and static heart rate) and monitoring heart rhythm (follow -up ECG, improve 24h dynamic ECG if necessary).
follow -up serum electrolyte level (Including blood potassium, magnesium, calcium), timely correction of electrolyte disorders.
Avoid use can affect the groundPay attention to the interaction between drugs at the concentration of Gaoxin blood.
Drug use taboos, the following people disabled the high Xin: ① Use calcium injection; ② those who are poisoned by the yellow -gymaline preparation; ③ ventricular tachycardia; ④ hypertrophic obstructive myocardial disease; ⑤ pre -excitation syndrome with AF or AFL.
Xin poisoning, stopping the medicine in time, intervention in the symptoms and/or electrolyte disorders; some cases can use anti-ground high-psia-Fab fragments for detoxification treatment.
References:
[1] Ma Bs, Yang K. Analysis of Serum Digoxin Concentration Monitoring Results and Influencing Factors in 127 Cases [J]. 195-2200.
[2] Andrews P, ANSEEUW K, Kotecha D, Lapostolle F, Thanacoody R. Diagnsis and Practical Management of Digoxin Toxicity: A Narrates IW and Consensus. Eur J Emerg Med. 2023 DEC 1; 30 (6 (6 (6 (6): 395-401.
[3] Wang Li, Yu Wenwen, Li Min, etc.Alert, 2023,20 (11): 1269-1272.
[4] CHAN BS, Buckley Na. Digoxin-SPECICICFIC ANTIBody Fragments in the Treatment of Digoxin TOLIN to xicol (Phila). 2014 SEP-OCT; 52 (8): 824-36.
[5] Chinese Medical Society Cardiovascular Disease Branch, Editorial Committee of China Cardiovascular Diseases Magazine.Clinical Application of Chinese Experts [J]. China Cardiovascular Disease Magazine, 2019, 47 (11): 857-864.
Responsible editor: Silver
