Digoxin toxicity in chronic renal failure: treatment by multiple dose activated charcoal intestinal dialysis
Digoxin toxicity in chronic renal failure: treatment by multiple dose activated charcoal intestinal dialysis
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DOI：
10.1177/096032719701601207
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发表时间：
1997-12-01
影响因子：
2.8
通讯作者：
Critchley, LAH
中科院分区：
文献类型：
--
作者：
Critchley, JAJH;Critchley, LAH
1地高辛中毒可由药物过量或医源性原因引起，尤其是肾功能受损时。2我们报告一例地高辛中毒，表现为严重心动过缓和低血压，患者为66岁男性，患有慢性肾功能衰竭。正如预期的那样，定期血液透析未能降低他的血浆地高辛浓度。地高辛特异性抗体片段（Fab）不容易获得，其使用可能不合适，因为它们通常经肾脏清除。3患者通过两个延长的肠透析疗程成功治疗，在48和72小时内重复给予活性炭，总量分别为400 g和600 g。然而，患者发现活性炭非常难吃。4最近提倡在广泛的中毒中使用多剂量活性炭肠透析（MDACID）。该技术利用小肠的大表面积来消除药物和代谢物，如果需要的话，可以持续几天。地高辛毒性在慢性肾功能衰竭中的药代动力学使肠透析成为一种适当的治疗方法，但该技术真正潜力的实现有待于更可口的吸收剂或制剂。
1 Digoxin toxicity can result from overdose or iatrogenic causes, especially if renal function is impaired.2 We present a case of digoxin toxicity presenting with severe bradycardia and hypotension in a 66 year old man with chronic renal failure. Regular haemodialysis had, as predicted, failed to reduce his plasma digoxin concentration. Digoxin specific antibody fragments (Fab) were not readily available and their use was probably inappropriate as they are normally renally eliminated.3 The patient was successfully treated by two prolonged courses of intestinal dialysis with repeated doses of activated charcoal over 48 and 72 h and totaling 400 g and 600 g, respectively. However, the patient found the activated charcoal extremely unpalatable.4 Multiple dose activated charcoal intestinal dialysis (MDACID) has been recently advocated for use in a wide range of poisonings. The technique takes advantage of the large surface area of the small intestine to eliminate drugs and metabolites, over several days if necessary. The pharmacokinetics of digoxin toxicity in chronic renal failure make intestinal dialysis an appropriate method of treatment but the realisation of the true potential of this technique awaits a more palatable absorbent or formulation.