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Wednesday, April 12

  1. page 2.1.6.1.2 Cardiac glycosides edited ... Vomiting should be controlled ASAP with medium to high doses of metoclopramide (10–50 mg IV) o…
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    Vomiting should be controlled ASAP with medium to high doses of metoclopramide (10–50 mg IV) or a 5HT3 antagonist (ondansetron, tropisetron, dolasetron etc.). Vomiting leads to electrolyte imbalances and increased vagal tone which may increase cardiac toxicity.
    Arrhythmias
    ...
    (Mg) abnormalities. With
    With
    chronic poisoning,
    ...
    digoxin poisoning. Patients often die with elevated digoxin concentration rather than from digoxin toxicities.
    Elimination enhancement
    Extracorporeal methods of elimination do not significantly increase digoxin clearance. Repeat dose charcoal may be useful. They have been shown to increase clearance and perhaps improve outcomes after yellow oleander poisoning and should be used if tolerated in all such ingestions. There is a small increase in clearance of digoxin with repeat doses of activated charcoal as there is some enterohepatic circulation (more significant in those with renal impairment). Repeat dose charcoal also increases clearance of digitoxin in animal models.
    Antidotes
    ...
    Fab fragments summary
    These digoxin specific antibodies bind rapidly to digoxin removing it from the Na+-K+-ATPase pump. The Fab-digoxin complex is then renally excreted. Total digoxin concentrations may increase many fold, however free serum digoxin concentrations fall. The Fab-digoxin complex is excreted with a half-life of 12 to 24 hours; however this may be greatly prolonged in the presence of renal failure.
    While Digoxin-Fab binds to digoxin in a 1:1 ratio the volume of distribution of digoxin is at least 10 times greater than Digoxin-Fab so much of the body’s digoxin burden is not available for immediate binding. In practice the clinical response to digoxin-Fab is rapid and most patients can be treated with repeated doses titrated to clinical response. For chronic digoxin toxicity it is suggested to give 40 mg (1 vial) at a time and reassess for further repeat doses after an hour. For acute poisoning it is recommended to give 80 mg (2 vials) and reassess. If patients are haemodynamically unstable a larger initial dose should be given. 1 This may be calculated based on the fact that digoxin-Fab 40 mg binds digoxin 0.5 mg. Hence, for example, ingestion of digoxin 3 mg could require up to 6 vials.
    Indications
    Life threatening dysrhythmias
    (view changes)
    5:29 pm
  2. page Drugs by class edited ... beta blockers calcium channel blockers ... glycosides including Digoxin> Digoxin b…
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    beta blockers
    calcium channel blockers
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    glycosides including Digoxin>Digoxin
    bufadienolides
    clonidine
    (view changes)
    5:25 pm
  3. page Drugs by class edited ... beta blockers calcium channel blockers cardiac glycosides including Digoxin> bufadien…
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    beta blockers
    calcium channel blockers
    cardiac glycosides including Digoxin>
    bufadienolides
    clonidine
    (view changes)
    5:23 pm

Sunday, March 26

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    8:40 am

Tuesday, March 14

  1. page 2.2.7.4.5 Organophosphates edited ... Mild acidosis is common in significant poisonings, the correction of the serum bicarbonate to …
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    Mild acidosis is common in significant poisonings, the correction of the serum bicarbonate to normal concentrations with sodium bicarbonate has been suggested to be clinically useful.
    Staff health issues
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    do not aprraciably off gas
    Staff should also
    Gown and glove
    ...
    Pralidoxime
    Pralidoxime binds to organophosphates and removes them from acetylcholinesterase if ageing has not occurred. The pralidoxime-organophosphate complex is water soluble and rapidly excreted by the kidneys.
    ...
    is controversial, IIn many institutions
    Reactivation is much more likely in diethyl organophosphates which age slowly than dimethyl organophosphates which age rapidly.
    Treatment should be tailored to the individual patient by ideally assessing for objective evidence of response following the initial dose. The best intermediat outcome would be improvement in power or in NMJ function, improvement in red cell cholinestersase is another intermetidate outcome often used.
    (view changes)
    12:11 am

Sunday, March 12

  1. msg thanks message posted thanks thanks
    thanks
    thanks
    4:49 pm

Monday, March 6

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