[Treatment of patients with acute digitalis poisoning by charcoal hemoperfusion]. / Lechenie na bolni s ostri otravianiia s digitalisovi preparati po metoda na karbokhemoperfuziiata.

10 patients with acute digitalis intoxication were treated by charcoal hemoperfusion. The patients had taken high toxic and lethal doses of digitalis drugs: 3 patients had taken 10 mg of (digitalin, 2 patients--7.5 mg of digoxin, 5 patients--10-25 mg of isolanid (ceglunat). 4 of the patients were with a heart disease and the other 6 patients did not have any heart disease. The charcoal hemoperfusion lasted 4 to 6 hours, in one female patient--2 hours. The mean minute volume was 100 to 150 ml/min, in some patients it reached up to 200 ml/min. The digoxin blood concentration was determined before and after the hemoperfusion in 4 patients and a decrease of 49% was found. 9 patients fully recovered and only one patient, a 70 years old women, who had not received antiarrhythmic treatment, died. Good results were also achieved in digitalin intoxications determined by the clinical course and the electrocardiographic data. The overall estimation of the method is that it is efficient and should be applied to patients with acute digitalis intoxication, always in combination with antidote, antiarrhythmic and cardioprotective treatment.

Intoxicaçäo digitálica: análise de 216 casos do HSE do Rio de Janeiro / Digitalis intoxication: review of 216 cases at the HSE of Rio de Janeiro

Foram revisados os prontuários de 216 pacientes do HSE do Rio de Janeiro que apresentavam intoxicaçäo digitálica e os resultados obtidos comparados com a literatura. Diversos parâmetros foram analisados, ressaltando-se que os mesmos foram correlacionados às drogas usadas. Houve maior incidência em pacientes do sexo masculino (81,93%), agrupados na faixa etária de 61 a 70 anos (34,72%). A insuficiência cardíaca estava presente em 67,12% dos pacientes. A droga mais utilizada foi digoxina (77,7%). As principais manifestaçöes clínicas foram: vômitos (53,24%), náuseas (52,77%) e descompensaçäo da insuficiência cardíaca (50%). A arritmia mais freqüêntemente encontrada foi extra-sístole ventricular multifocal (25,88%). Houve boa resposta à terapêutica conservadora em 86,11% dos pacientes, sendo que 2,78% evoluíram para o óbito

[Immunological treatment of digitalis poisoning with heterologous antibodies]. / Immunologische Behandlung der Digitalis-Intoxikation mit heterologen Antikörpern.

Our own experience with the production of digoxin-specific antibody preparations from the sheep and the results of the experimental and clinical use are briefly reviewed. Advantages, risks and unsolved problems of therapy with glycoside-specific antibodies are discussed.

Treatment of a case of lanatoside C intoxication with digoxin-specific F(ab')2 antibody fragments.

In animal experiments arrhythmias induced by cardiac glycosides which prove fatal if untreated can be terminated by administration of glycoside-specific antibodies. Immunotherapy with digoxin-specific antibody fragments had hitherto only been employed on one occasion, namely in a person who had taken a massive overdose of digoxin with suicidal intent and who had failed to respond to symptomatic treatment. The present paper describes the use of F(ab')2 fragments of digoxin-specific antibodies in a female patient with lanatoside C intoxication to treat the associated life-threatening cardiac arrhythmia. The arrhythmia was rapidly terminated and normal sinus rhythm was restored. Treatment with the heterologous antibodies did not cause any side-effects.

[The clinical significance of plasma glycoside concentrations in patients with cardiac pacemakers (author's transl)]. / Verhalten und Aussagewert von Glykosidplasmaspiegeln bei Herzschrittmacherpatienten.

308 digitalized out-patients with artificial cardiac pacemakers were explored for signs of glycoside toxicity with simultaneous determination of digoxin plasma levels 12 hours after the last dose. The incidence of different side effects commonly attributed to overdigitalization did not allow prediction of toxic plasma levels. 55% of all glycoside levels were within the therapeutic range, 34% were below 0.7 ng/ml and only 11% above 2.0 ng/ml. With the most commonly prescribed maintenance doses of the glycosides used (digoxin 0.5 mg, beta-acetyldigoxin 0.4 mg, beta-methyldigoxin 0.2 mg, lanatosid C 1.0 mg) therapeutic plasma levels were reached regularly in 60-65% of the patients. A significant correlation existed between plasma glycoside concentrations and renal function as well as age, but glycoside concentrations could not be correlated with the age of the patients. There were no indications for interactions of the different glycosides prescribed with diuretics or oral antidiabetics.

[Clinical and pharmacokinetic studies in patients with digitalis intoxication (author's transl)]. / Klinische und pharmakokinetische Untersuchungen zur Digitalisintoxikation

6 patients with severe digitalis intoxication were studied while hospitalised in a coronary care unit. 2 and 4 patients had ingested high doses of lanatosid C and digoxin, respectively. In three cases ventricular arrhythmias, in one of these and two further cases SA blocking and an additional A-V-block in one case were observed. Maximum blood levels of digoxin between 3.4 and 20 ng/ml were determined several hours after the ingestion. The maximal blood levels were achieved in one patient only 52 h after ingesting lanatosid C and in one patient taking digoxin after 12.5 h. Potassium concentrations in plasma were elevated in 4 patients. Antiarrhythmic and electrolyte therapy is discussed and the usefulness of a stomach lavage for diminishing the quantity of absorbed lanatosid C is shown in one patient who had a maximal blood level of 3.4 ng/ml after taking 23.7 mg of lanatosid C. Cumulative urinary excretion of this patient was 0.68 mg within 5.5 days. This result confirms the minimal enteral absorption under the therapy chosen.

[Clinical trial of the Bulgarian digitalis preparation, Digilanide C used intravenously]. / Klinichno izpitvane na bulgarskiia digitalisov preparat Digilanid C za venozno prilozhenie

The Bulgarian digitalis preparation Digilanid C for venous application has a satisc factory effect on the majority of the patients (67 per cent) with light and moderate chronic cardia insufficiency and espically in case of tachycardia in auricular fibrillation. The comparison of the results between the group of 46 patients, treated with Digilanid C and the control group of 20 patients treated with Isolanid (Richter) do not reveal essential differences in the major part of the results obtained.