Resumo
Definição
Anamnesis y examen
Principales factores de diagnóstico
- presença de fatores de risco
- exposição à digoxina
- sintomas gastrointestinais
- sintomas do sistema nervoso central
- sintomas visuais
Otros factores de diagnóstico
- probabilidade de suicídio
- sintomas cardiovasculares
Factores de riesgo
- idade >55 anos
- clearance renal diminuído
- hipercalemia (>5.0 milimoles/L)
- hipocalemia (<3.0 a 3.5 milimoles/L)
- uso concomitante de medicamentos específicos
- hipomagnesemia
- hipercalcemia
- hipotireoidismo
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- eletrocardiograma (ECG)
- concentração sérica de digoxina
- nível de potássio sérico
- nível de magnésio sérico
- creatinina sérica e ureia
Algoritmo de tratamiento
ingestão aguda, toxicidade baixa a moderada
ingestão crônica, toxicidade baixa a moderada
toxicidade grave ou comprometimento hemodinâmico (toxicidade aguda ou crônica)
toxicidade aguda ou crônica após início do tratamento
Colaboradores
Autores
Scott Phillips, MD
Associate Clinical Professor of Medicine
Department of Clinical Pharmacology and Toxicology
University of Colorado
Denver
CO
Associate Medical Director
Washington Poison Center
Seattle
WA
Divulgaciones
SP declares that he has no competing interests.
Agradecimientos
Dr Scott Phillips would like to gratefully acknowledge Dr Oladapo A. Odujube and Dr Robert S. Hoffman, previous contributors to this topic.
Divulgaciones
OAO and RSH declare that they have no competing interests.
Revisores por pares
Edward W. Boyer, MD
University of Massachusetts Medical School
Worcester
MA
Divulgaciones
EWB declares that he has no competing interests.
Ruben Thanacoody, MD, FRCP(Edin)
Consultant Physician and Clinical Toxicologist
National Poisons Information Service (Newcastle)
Newcastle-upon-Tyne
UK
Divulgaciones
RT declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referencias
Artículos principales
Gheorghiade M, van Veldhuisen DJ, Colucci WS. Contemporary use of digoxin in the management of cardiovascular disorders. Circulation. 2006 May 30;113(21):2556-64. Resumen
Smith TW, Haber E, Yeatman L, et al. Reversal of advanced digoxin intoxication with Fab fragments of digoxin-specific antibodies. N Engl J Med. 1976 Apr 8;294(15):797-800. Resumen
Smith TW, Butler VP Jr, Haber E, et al. Treatment of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments: experience in 26 cases. N Engl J Med. 1982 Nov 25;307(22):1357-62. Resumen
Bismuth C, Gaultier M, Conso F, et al. Hyperkalemia in acute digitalis poisoning: prognostic significance and therapeutic implications. Clin Toxicol. 1973;6(2):153-62. Resumen
Taboulet P, Baud FJ, Bismuth C, et al. Acute digitalis intoxication--is pacing still appropriate? J Toxicol Clin Toxicol. 1993;31(2):261-73. Resumen
Artículos de referencia
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