Cardioactive steroid poisoning: a comparison of plant- and animal-derived compounds.
J Med Toxicol
; 2(4): 152-5, 2006 Dec.
Article
en En
| MEDLINE
| ID: mdl-18072135
ABSTRACT
INTRODUCTION:
Cardioactive steroids (CASs) are found in plants, animals, and insects. Their affinity for Na+-K+ ATPase is attenuated by the type of lactone at carbon 17 (C17) of the steroid backbone those with 5-membered lactone rings, or cardenolides, are derived mostly from plants with 6-membered rings or from animals with bufadienolides. A systematic review of CAS poisoning was performed to compare the mortality rate of cardenolides and bufadienolides.METHODS:
MEDLINE was searched for articles using commonly reported names of CASs, and keywords were limited to human cases only. We searched cases from 1982 to 2003, so that supportive care was similar and digoxin-specific Fab was available. Identified reports of CAS poisoning were read to exclude cases involving licensed pharmaceuticals. Inclusion criteria included hyperkalemia, gastrointestinal symptoms, electrocardiographic evidence of CAS toxicity, digoxin serum concentration, or history of exposure to a substance containing a CAS. Clinical data was collected, including information about treatment with digoxin-specific Fab and treatment outcome.RESULTS:
Fifty-nine articles, describing 924 patients, were identified. Eight hundred ninety-seven patients (97%) ingested a CAS with a 5-membered lactone ring, and mortality was 6% (n = 54). Twenty-seven patients (2.9%) ingested a CAS with a 6-membered lactone ring, and mortality was 29.6% (n = 8). The difference in mortality rates was statistically significant (p < 0.001, [X2]). CASs with 6-member rings accounted for the highest percentage of nonsuicidal exposures.CONCLUSION:
Although cardenolides accounted for the majority of exposures, bufadienolides were five times more lethal than cardenolides.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
3_ND
Problema de salud:
3_zoonosis
Asunto principal:
Bufanólidos
/
Cardenólidos
/
Cardiotónicos
/
Preparaciones de Plantas
Tipo de estudio:
Prognostic_studies
/
Systematic_reviews
Límite:
Animals
Idioma:
En
Revista:
J Med Toxicol
Asunto de la revista:
TOXICOLOGIA
Año:
2006
Tipo del documento:
Article
País de afiliación:
Estados Unidos