Help with glycoside intoxication. Antidote for poisoning with cardiac glycosides. Treatment of digitalis intoxication

Digitalis intoxication (poisoning with cardiac glycosides) is a serious complication of the treatment of patients suffering from heart disease and taking drugs of the digitalis group (digoxin).

Lethal doses of cardiac glycosides are usually 10 times or more higher than therapeutic doses. The elderly and patients with impaired function are especially sensitive to them. thyroid gland, circulatory and excretory systems. The toxicity of digitalis group drugs increases in the presence of hypokalemia and hypomagnesemia. Children are more resistant to them.

The duration of the toxicogenic stage correlates with the rate and completeness of absorption of cardiac glycosides in the gastrointestinal tract, the rate of their binding by plasma proteins and excretion. It is quite long-lasting in people with intoxication, poisoned with digitoxin and isolanide, through the hepatic intestinal circulation and significant reabsorption in the kidneys. In particular, digitoxin binds to plasma proteins by 90%, digoxin by 40%, and strophanthin by less than 10%. Every day, the activity of strophanthin in the blood decreases by 40-50%, while digitoxin decreases by 7-10%. Due to the low (3.5%) absorption of strophanthin and digitoxin in the gastrointestinal tract, oral poisoning with them has not been recorded.

Manifestations of acute poisoning with cardiac glycosides do not depend on the route of entry into the body.

The clinical picture of digitalis intoxication consists of several leading syndromes, in particular:

gastrointestinal,
cardiovascular,
psychoneurological and
visual disturbances.

First of all, dyspeptic manifestations appear in the form of nausea, continuous vomiting with an admixture of bile in the vomit, sometimes blood, diarrhea, signs of dehydration, and abdominal pain. Soon appears headache, dizziness and visual impairment in the form of ring-shaped scotomas, xanthopsia, decreased visual acuity as a result of the development of retrobulbar neuritis. Ataxia, insomnia, agitation, delirium, hallucinations, convulsions, shortness of breath, cyanosis, hypoxia, and decreased diuresis are also characteristic.

On the ECG, along with a decrease in the ST interval and a negative or flattened T wave, the PQ interval lengthens, single atrial P waves fall out. Rhythm and conduction disorders of all types are often observed, especially when acute poisoning with cardiac glycosides was preceded by cardiac disturbances: bradycardia, blockade and etc.. The development of ventricular extrasystole of the bigeminy type is very dangerous, paroxysmal tachycardia, atrial and ventricular fibrillation. In such cases, death occurs due to cardiac arrest or asphyxia.

Emergency care for digitalis intoxication

Delivery program emergency care in case of acute intoxication with cardiac glycosides, it provides for early detoxification with resuscitation measures and antidotes, interruption of enterohepatic circulation (if poisoning occurs with digitoxin or isolanide), elimination of manifestations of PSCE, arrhythmia, vomiting, agitation and hypoxia, improvement of myocardial contractile function. To do this you need:

a) stop treatment with cardiac glycosides;
b) administer unithiol, vitamin E and glycocorticoids to reduce the manifestations of PSCE on the first day - 3-4 times, in subsequent days - 2-3 times;
c) rinse the stomach again, administer a saline laxative through a tube and Activated carbon to prevent the absorption of poison into the gastrointestinal tract. Also take 200 ml of petroleum jelly or 8 g of cholestyramine orally, which will stop circulation if intoxication is caused by digitoxin or isolanide;
d) provide oxygen inhalation, infusion of 5-10% glucose with insulin, cocarboxylase, vitamin B6 intravenously;
e) normalize the rhythm and conductivity of the heart with antiarrhythmic drugs, with the exception of procainamide and quinidine, which are contraindicated. If there is no effect, perform cardiac pacing or defibrillation;
f) in the presence of vomiting and agitation, administer parenterally diprazine 1 ml of 2.5% solution, promedol 1 ml of 1% solution or one of the antipsychotic drugs (droperidol - 1-2 ml of 0.25% solution or aminazine - 1-2 milliliters 2, 5% solution). Use a polarizing mixture as an antiarrhythmic agent;
f) reduce the effect of endogenous calcium on the contractile function of the myocardium due to the disodium salt of ethylenediaminetetraacetic acid 3-4 g in 500 milliliters of 5% glucose intravenously, 2% sodium citrate solution 5 ml/kg verapamil 1-2 milliliters of 0.25% solution or other calcium channel blockers (Phenigidine, etc.);
g) to normalize myocardial excitability (in case of arrhythmia, cardiogenic collapse), administer intravenously 10% thetacine-calcium in a 5% glucose solution or isotonic sodium chloride solution in a single dose of 15-25 mg/kg, daily - 30-75 mg/kg ;
c) in the presence of hypokalemia, use potassium preparations (panangin, potassium chloride, potassium and sodium aspartate).

Antidote for cardiac glycoside poisoning

A specific antidote for digitalis intoxication with cardiac glycosides, in particular digoxin preparations, are fragments of specific antibodies against digoxin. The essence of their antidote activity lies in binding free digoxin contained in plasma after its absolute or relative overdose, and thus preventing its interaction with myocardial cells. The drug is used in a dose that is molecularly adequate to the amount of digitalis glycoside that is absorbed. (Empirically it has been established that this dose is 800 mg, that is, 20 ampoules of 40 mg each).

Fragments of specific antibodies against digoxin are obtained from specific antibodies that were formed in the body of sheep. Their relationship with digoxin, as well as digitoxin and lantoside, is greater than the relationship of these glycosides with specific receptors (ATPase) in the myocardium. Therefore, these glycosides bind predominantly to fragments of specific antibodies, and not to specific receptors in the myocardium and other tissues. 30 minutes after the administration of the antidote, the content of digoxin or another glycoside in the blood begins to increase, which contributes to intoxication; glycosides combined with protein lose their pharmacological activity and are excreted from the body. The dose of the drug is set individually and depends on the amount of glycoside that is absorbed.

Intoxication with cardiac glycosides is more often caused by a decrease in tolerance than a true overdose.

Factors contributing to intoxication with cardiac glycosides:

The occurrence of glycoside intoxication can be facilitated by:

1) the proximity of the full therapeutic and toxic doses of glycosides;

2) decreased tolerance or complete intolerance to glycosides due to severe myocardial damage;

3) general potassium deficiency (treatment with potassium-removing diuretics; metabolic alkalosis and increased kaliuresis due to the use of large doses of glucocorticosteroids);

4) myocardial hypocaligistia during myocardial infarction, myocarditis; myocardial hypoxia as a result of arterial hypoxemia in acute and chronic diseases lungs, pleural effusions; pulmonary thromboembolism; chronic pulmonary heart disease;

5) electropulse therapy after previous digitalization (it is believed that this therapy leads to loss of myocardial potassium);

6) previous glycoside intoxication increases the sensitivity of the myocardium during subsequent administration of glycosides, especially in the near future. This is explained, along with myocardial hypocaligistia, by the occurrence of so-called Buchner myocardial necrosis;

7) hypercalcemia;

8) hypomagnesemia;

9) renal failure (decreased elimination of cardiac glycosides);

10) liver failure(slowing down the processes of destruction of cardiac glycosides; reducing the deactivation of hormones that affect water and electrolyte balance - secondary hyperaldosteronism);

11) simultaneous use of certain drugs (calcium chloride, especially when administered intravenously, catecholamines, aerosol sympathomimetics in patients bronchial asthma And pulmonary heart, aminophylline, in rare cases - rauwolfia preparations);

12) elderly and senile age.

Symptoms of intoxication with cardiac glycosides:

Among clinical manifestations glycoside intoxication, first of all, cardiovascular disorders should be noted. An increase in circulatory failure is noted as a manifestation of the damaging effect of toxic doses of glycosides on the myocardium; Heart rhythm and conduction disturbances are the most common and sometimes dangerous manifestations of glycoside intoxication. With glycoside intoxication there are:

a) disturbances in the formation of the sinus impulse (sinus tachycardia and bradycardia, sinus node paralysis, sinoatrial block);

b) atrial arrhythmias (atrial tachycardia with and without incomplete atrioventricular block, atrial extrasystoles, migration of the pacemaker through the atria, atrial fibrillation and flutter);

c) nodal tachycardia, nodal extrasystoles, nodal rhythms;

d) ventricular rhythm disturbances (ventricular extrasystoles, including bigeminy, frequent and polytopic extrasystoles; ventricular tachycardia; ventricular fibrillation);

d) various degrees atrioventricular block; Frederick's phenomenon (complete atrioventricular block in combination with atrial fibrillation, which preceded the development of digitalis intoxication). Thus, with glycoside intoxication, almost any type of rhythm and conduction disturbances occurs. The most common, however, are ventricular extrasystole, especially bigeminy with polymorphic ventricular complexes.

In doubtful cases with ectopic arrhythmias for differential diagnosis a test with intravenous drip administration of a 2% sodium citrate solution can be used. At the same time, the content of ionized calcium (a synergist of glycosides) in the blood decreases and glycoside arrhythmias are eliminated. The test is specific in the diagnosis of glycoside intoxication.

Gastrointestinal symptoms(loss of appetite, nausea, vomiting, rarely diarrhea) is associated mainly with direct or reflex stimulation of the vomiting center by toxic doses of cardiac glycosides. There is a decrease in daily diuresis.

Cardiac glycosides may cause visual disturbances (objects appear colored yellow, less often there is a sensation of flickering “fly spots” before the eyes, scotomas are noted, the perception of objects in a reduced or enlarged form; decreased visual acuity). Neurological symptoms (insomnia, headache, dizziness, depression, confusion, aphasia, delirium, neuritis trigeminal nerve, radiculitis, intercostal neuralgia, paresthesia upper limbs) sometimes serve as the only manifestation of intoxication. Cases of gynecomastia have been described.

Prevention of glycoside intoxication:

Measures to prevent glycoside intoxication include, first of all, the rational prescription of glycosides, taking into account contraindications, as well as factors that contribute to a decrease in tolerance to glycosides; rational dosing with careful monitoring of the treatment effect.

It is also necessary to carry out measures aimed at increasing tolerance to cardiac glycosides:

a) treatment of the underlying disease and its complications (myocarditis, bacterial endocarditis, chronic pulmonary infection, thromboembolic complications) using, respectively, antibiotics, thrombolytic agents and anticoagulants, glucocorticosteroids, etc.;

b) bloodletting for refractory right ventricular failure, symptomatic polycythemia;

V) pleural puncture, paracentesis in the presence of hydrothorax and ascites, which impairs pulmonary ventilation;

d) administration of respiratory analeptics (cordiamin, aminophylline), assisted breathing in case of severe respiratory failure and respiratory rhythm disturbances;

e) oxygenation; in case of refractory heart failure, hyperbaric oxygen therapy increases tolerance to cardiac glycosides;

f) the use of drugs that help improve myocardial metabolism (inosine, riboxin, anabolic agents - retabolil, nerobol, potassium orotate);

g) prescription of spirolactones (veroshpiron) in combination with glucocorticosteroids and diuretics for severe heart failure and secondary hyperaldosteronism;

h) prophylactic administration of potassium salts, panangin, and sometimes polarizing mixtures;

i) timely withdrawal of drugs that reduce tolerance to glycosides (calcium chloride, sympathomimetics such as isadrin, etc.);

j) to prevent post-defibrillation arrhythmias - timely withdrawal of digitalis drugs (isolanide, digoxin 3-5 days; digitoxin, digitalis leaf powder, acedoxin - 7-10 days before electrical pulse therapy).

Treatment of glycoside intoxication:

Treatment of glycoside intoxication begins primarily with the withdrawal of cardiac glycosides when signs of intoxication with them appear. In mild cases, withdrawal of glycosides may be sufficient to eliminate symptoms of intoxication. In addition, they carry out a set of measures listed in the section “Prevention of glycoside intoxication” (see above).

It is advisable to divide drugs used in the treatment of glycoside intoxication into two groups.

Group I of drugs used in the treatment of intoxication with cardiac glycosides:

The first group includes drugs used in all cases of glycoside intoxication, including digitalis heart block:

1. Unithiol is administered 5 ml of a 5% solution intramuscularly 2-3 times a day for 3-6 days, then 5 ml intramuscularly 1 time a day for another 2-4 days. When resuming treatment with glycosides, to increase tolerance to them, unithiol 5 ml is administered intramuscularly 30 minutes before the administration of strophanthin or korglykon.

2. Oxygenation, hyperbaric oxygen therapy.

3. Introduction of complexons to bind ionized calcium. When 50–250 ml of 2% sodium citrate solution is administered intravenously, the therapeutic effect occurs within a few minutes (mainly for ectopic rhythm disturbances), but lasts no more than 20 minutes. Side effects are unknown. When prescribing 3–4 g of disodium salt of ethylenediaminetetraacetic acid (Na2EDTA) in 250 ml of 5% glucose solution, a rapid but short-term effect is observed. Frequently side effects(feeling of heat, nausea, dizziness, pain along the vein).

4. Diphenin inhibits ectopic activity, while simultaneously improving atrioventricular conduction. The drug is effective both in the treatment of ectopic rhythm disturbances and atrioventricular conduction disorders of glycoside origin (excluding complete atrioventricular blockades). Difenin is administered intravenously at a dose of 125–250 mg over 1–3 minutes. If necessary, the drug is re-administered every 5–10 minutes until a therapeutic effect is achieved under constant electrocardiographic monitoring. To maintain the antiarrhythmic effect, 50–100 mg is prescribed orally 4 times a day. Difenin is contraindicated in severe sinus bradycardia, sinoatrial block, complete atrioventricular block.

5. Bretylium tosylate is administered at a dose of 400–600 mg intramuscularly. The effect occurs after 15 minutes, the maximum effect after 2–3 hours, the duration of action is up to 20 hours. The drug does not change or increase atrioventricular conductivity and enhances myocardial contractility.

6. For severe digitalis bradycardia and atrioventricular conduction disturbances, intravenous or subcutaneous administration of atropine at a dose of 0.5–1 mg every 4 hours is indicated. The drug is also indicated for slow nodal rhythm, weakness of the sinus node and sinoatrial block, when the heart rate is less than 50 bpm minute and there are disturbances in the blood supply to the brain, an increase in angina attacks and an increase in heart failure.

If there is no effect of atropine for supraventricular bradycardia, temporary transvenous pacing with a demand pacemaker can be used.

With complete atrioventricular block and incomplete atrioventricular block of the second degree, atropine is less effective. The use of drugs such as isoprenaline should be avoided due to the risk of severe ventricular tachyarrhythmias. In case of Adams-Stokes-Morgagni syndrome or the danger of its occurrence (complete atrioventricular block with severe bradycardia), temporary cardiac pacing is indicated.

Group II of drugs used in the treatment of intoxication with cardiac glycosides:

The second group of drugs includes drugs used for glycoside intoxication with ectopic heart rhythm disturbances and the absence of blockades. Prescribed:

1. Potassium preparations. Potassium chloride is used orally up to 6–8 g/day in solution or intravenously at the rate of 1.0–1.5 g of the drug in 0.5 l of isotonic glucose solution with 4–8 units of insulin (polarizing mixture). Administered dropwise over 3 hours under electrocardiographic control in order to timely detect possible hyperkalemia (appearance of pointed T waves, disappearance of P waves, conduction disturbances). Panangin is prescribed orally up to 6 tablets per day or intravenously 1-3 ampoules (10-30 ml) in 150-200 ml of isotonic sodium chloride solution or as part of a polarizing mixture (150-200 ml of 5% glucose solution and 4-8 units of insulin) .

2. Lidocaine is administered intravenously as a bolus (80–120 mg over 5–10 minutes). Since the effect of lidocaine with the intravenous jet method of administration lasts about 30 minutes, if necessary, treatment is continued by drip intravenous administration of 500 mg of lidocaine in 500 ml of 5% glucose solution at a rate of 40-50 drops (1-2 mg of lidocaine) per minute.

3. Ethmozin, a drug with quinidine-like action, is administered intravenously in a stream of 2–4 ml of a 2.5% solution in an isotonic sodium chloride solution (over 5–7 minutes), as well as intramuscularly. Orally prescribed in tablets of 25 mg (up to 150–300 mg/day).

4. Isoptin (verapamil) is most effective for supraventricular tachycardias and tachyarrhythmias. Intravenously administered at a dose of 5–10 mg over 20–30 s. For maintenance treatment and in milder cases of digitalis arrhythmia (extrasystole), isoptin is administered orally at a dose of 40–80 mg 3 times a day.

5. If nausea and vomiting occur as a result of glycoside intoxication, use metoclopramide (Raglan; Cerucal) 10 mg 3 times a day intramuscularly.

Intoxication with cardiac glycosides is a severe poisoning that occurs among people with pathologies of the heart muscle, since only they take digitalis (digitalis) preparations.

The greatest sensitivity to drugs in this group is observed among elderly people, as well as patients with diseases of the excretory and circulatory systems, and the thyroid gland.

The toxicity of cardiac glycosides increases in the case of hypomagnesemia and hypokalemia.

The development of acute intoxication with cardiac glycosides is possible regardless of the route of their entry into the human body (orally or by injection).

Digitalis intoxication most often occurs while taking Digoxin, since it is the most used medication among cardiac glycosides. Digitoxin and Celanide are used much less frequently, and only in a hospital setting.

The drugs in this group have a fairly narrow “therapeutic window”, i.e. even a minimal overdose can provoke very serious consequences, causing severe poisoning with possible fatal. Symptoms of poisoning occur even when the therapeutic dose is doubled, and increasing this dose by 5-10 times creates a danger of death.

Digitalis drugs have accumulative properties. They bind to plasma proteins and then remain in the bloodstream for a long time.

Digitalis intoxication can occur for the following reasons:

exceeding the therapeutic dose of the drug;
advanced age;
severe degrees of renal and liver failure;
diseases of cardio-vascular system: myocarditis, coronary heart disease, previous operations, etc.;
decreased level of potassium in the blood plasma, which occurs due to the use of diuretics, and sometimes with a secondary form of hyperaldosteronism;
the presence of an imbalance of other microelements (hypomagnesemia, hypercalcemia);
conditions that provoke hypoxia: lung diseases and heart failure;
use of antiarrhythmic drugs - Cordarone, Verapamil, Quinidine;
use of macrolide antibiotics;
diseases of the thyroid gland with increased synthesis of its hormones.

When intoxicated with these drugs, a powerful imbalance of electrolytes occurs in the heart cells. They accumulate calcium and sodium, but the amount of potassium is significantly reduced. Such transformations lead to an increase in the strength of heart contractions. At the same time, Digoxin reduces the speed of impulses passing through the conduction system of the heart. These changes lead to the development of digitalis intoxication.

Clinical picture of poisoning

The first signs of intoxication with digitalis preparations are detected on the ECG, when there is still no clinical evidence of poisoning. An electrocardiogram demonstrates a variety of heart rhythm disturbances:

tachycardia (increased heart rate);
blockades;
extrasystole (extraordinary contractions of the myocardium);
fibrillation (“flutter”) of the ventricles and atria.

Other changes are also observed, but only qualified doctors can detect them. If you don't start helping early stage intoxication, clinical symptoms will begin to appear.

There are several groups of clinical signs.

Symptoms of heart muscle damage:

arrhythmia, cardiac arrest;
signs of ischemia (intense chest pain).

Damage to the gastrointestinal tract:

diarrhea;
lack of appetite;
vomit;
nausea.

Neurological changes:

insomnia;
fatigue and weakness;
dizziness;
psychosis;
depression;
migraine.

Damage to the organs of vision:

dots and spots before the eyes;
impaired color perception (yellow-green tones predominate);
fear of bright light;
unclear and blurry image;
blindness.

The acute form of poisoning is characterized by the rapid (several minutes or hours after consuming Digoxin) development of a pronounced clinical picture. In this case, the patient’s condition sharply worsens, which is accompanied by convulsions, a drop in blood pressure and cardiac arrest.

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Specifics of treatment of cardiac glycoside poisoning

In case of Digoxin intoxication, it is important to provide first aid in a timely manner and begin treatment. As for therapy, it consists of a corresponding number of important activities:

discontinuation of cardiac glycosides;
removing toxins from human body. To do this, you need to take the appropriate sorbents: activated carbon, Polysorb, Smecta, Atoxyl, etc. Then you should rinse the stomach, but this is done only in emergency cases. Sometimes salt laxatives are used: sodium or magnesium sulfate, as well as Carlsbad salt;
in severe cases, potassium chloride is administered intravenously, and in milder cases - orally, but only after meals;
choice of arrhythmic medicines depends on the type of arrhythmia;
specific antidotes for cardiac glycosides are Digitalis-antidote BM and Unithiol;
in rare cases, cardiac pacing is performed;
symptomatic therapy includes intravenous administration saline and glucose, the use of psychotropic drugs, and oxygen therapy.

Prevention of digitalis intoxication

Prevention of poisoning with digitalis drugs consists of careful selection of the dose of the drug. Take glycosides only as prescribed by a doctor!

The course of treatment must be accompanied constant control ECG dynamics, as well as blood electrolyte levels (monitoring potassium concentration is most important).

The patient should inform the cardiologist about the medications he is taking to treat concomitant diseases (antibiotics, diuretics, antiarrhythmics, etc.).

Be sure to include potassium-rich foods in your diet (dried apricots, prunes, raisins, potatoes in their skins).

Thus, poisoning with cardiac glycosides is a very dangerous and insidious phenomenon. If timely assistance is not provided and therapy is not started, a person may die due to cardiac arrest.

Cardiac glycosides are a group medicines which are indicated for the treatment of certain cardiac diseases. Uncontrolled or improper use can lead to severe poisoning. In this article, we examined the reasons why digitalis intoxication may develop, its signs and symptoms, and methods of providing first aid. first aid and elements of treatment.

What are cardiac glycosides, for what diseases are they prescribed?

Cardiac glycosides are drugs that used to treat heart failure and various violations rhythm. The most commonly used drug in medicine is Digoxin, which is made from the Digitalis lanata plant. The following representatives of this group also apply:

"Strophanthin";
"Korglikon";
"Digitoxin";
"Celanid".

Please note that cardiac glycosides can only be taken as prescribed by a doctor. If they are used incorrectly, severe violations in the functioning of the whole organism, the cardiovascular system especially suffers.

Cardiac glycosides are prescribed for the following pathologies:

chronic heart failure with symptoms of circulatory stagnation;
atrial fibrillation;
atrial fibrillation;
paroxysmal tachycardia.

Causes of cardiac glycoside poisoning

Glycoside intoxication can develop for many reasons. Taking these medications requires the patient to comply with all recommendations given to him by the attending doctor.. The following are the main reasons why cardiac glycoside poisoning may develop:

Overdose of cardiac glycosides. It develops as a result of taking large doses of the drug.
Impaired kidney function in a patient, as a result of which drugs cannot be fully eliminated from the body and accumulate in it, causing intoxication.
A sharp decrease in potassium levels in the blood, which most often develops as a result of uncontrolled use of diuretics. Patients with congestive heart failure suffer from severe edema and take diuretics to quickly remove fluid.
Acute or chronic liver failure. Enzyme reactions that metabolize cardiac glycosides occur in the liver.
The patient has severe heart disease ( coronary disease heart, cicatricial changes in the myocardium, myocarditis).
Hyperthyroidism is an overworking of the thyroid gland, in which the level of hormones in the blood increases sharply.
Decrease in the amount of protein in the blood.

Clinical signs of digitalis intoxication

Symptoms of an overdose of cardiac glycosides can increase slowly or quickly. The time depends on the severity of the poisoning. First of all, signs of dysfunction of the heart and digestive system appear..

note that acute intoxication cardiac glycosides can cause immediate cardiac arrest.

The following are signs of an overdose of cardiac glycosides:

Appearance pain in the area of the heart, the development of an attack of angina pectoris. The pain is burning and squeezing. With absence drug treatment As a rule, it goes away on its own within 10-15 minutes.
A feeling of disruptions in the functioning of the heart, indicating the development of arrhythmia.
Anorexia – lack of appetite.
Nausea, vomiting, diarrhea and abdominal pain.
Severe pain in the head, reminiscent of a migraine attack.
General weakness, drowsiness and apathy. The patient may develop an anxiety attack.
Feeling of floating spots in front of the eyes, decreased visual acuity up to complete blindness.
A sharp decrease in blood pressure.
Development of generalized convulsions throughout the body, as in an epileptic seizure. Convulsions may develop against the background of absent consciousness.
Loss of consciousness and falling into a deep coma - signs of total damage to the central nervous system due to acute heart failure and increasing hypoxia.

What to do in case of acute glycoside poisoning

If a person taking cardiac glycosides begins to show the first signs of intoxication, You should immediately stop taking these medications and call ambulance .

Please note that self-medicating digitalis intoxication is very dangerous. A poisoned patient can die at any moment from respiratory arrest. Only doctors can objectively assess the severity of a poisoned person’s condition and prescribe the correct treatment.

Before doctors arrive, you should begin first aid. Thanks to it, you can slightly improve the patient’s condition and give him a chance to wait for the doctors. Below is a description of the actions you can take to help a patient while waiting for an emergency medical team:

Give the patient a drink in one gulp a large number of water and explain to him the need to tear it out. Vomiting can be provoked by pressing your finger on the root of the tongue. This procedure will help remove the remaining drug from the stomach.
Find drugs from the group of sorbents in your home medicine cabinet and give them to the patient to drink. This can be activated carbon, atoxyl, smecta, sorbex, enterosgel, etc. Sorbents partially neutralize drugs that remain in digestive system , and will help avoid increased intoxication.
Give the poisoned person warm, sweet tea or plain water. Place him on the bed and open the windows for ventilation.

If a person has lost consciousness before paramedics arrive, you should turn his head to the side so that he does not choke on vomit. Monitor his pulse and breathing, and when they stop, begin performing chest compressions.

Medical care and treatment

SPM doctors, upon arriving at a call, will collect anamnesis and conduct a quick assessment of the patient’s condition. First they will check arterial pressure, pulse and respiratory rate, saturation level, and then an electrocardiogram will be taken.

After the administration of medications necessary to maintain vital signs, the patient is urgently transported to the intensive care unit.

When treating digitalis intoxication, it is necessary to use an antidote– specific antibodies against digoxin. This antidote helps remove and neutralize drug residues.

Therapy for cardiac glycoside poisoning consists of the following components:

Supply oxygen to the patient through a mask.
Intravenous administration of drugs to normalize electrolyte balance (carried out under the control of blood tests).
Administration of atropine to speed up the pulse.
Anticonvulsants.
Droppers with solutions to reduce dehydration.
In case of severe poisoning, hemodialysis is performed - blood purification using an artificial kidney.

The prognosis for a patient’s life depends on the dose of the drug with which he was poisoned., timely first aid and the condition of the body as a whole, the presence of concomitant pathologies.

Digitalis intoxication develops as a result of improper treatment with cardiac glycosides. The dosage of these drugs is calculated by the doctor individually for each patient and must be strictly adhered to. When the first signs of cardiac glycoside poisoning appear, you should call an ambulance. Treatment in a hospital is prescribed based on the severity of the patient’s condition. In case of severe poisoning, hemodialysis is indicated.

At acute poisoning heart muscle is affected very often, and in severe intoxication, as a rule. In this case, the basis of the pathological process is myocardial dystrophy. In some cases, myocardial dystrophy can be associated with the direct effect of poison on metabolic processes in the myocardium (specific cardiotoxic effect), in others - with the indirect influence of disorders that occur in the body during intoxication (nonspecific cardiotoxic effect). The latter include hypoxic conditions, circulatory disorders (shock, collapse), disturbances of the acid-base state, water-salt balance, vitamin deficiency, increased catecholamines, increased load on the heart muscle, etc. The significance of each of these reasons may vary depending on the the nature of the poison, the severity of intoxication and the accompanying complications.

With many intoxications the main factor leading to myocardial dystrophy is hypoxic conditions. They can be of the nature of hypoxic hypoxia (poisoning with narcotic and asphyxiating substances, etc.), hemic (poisoning with carbon monoxide and methemoglobin formers), tissue (poisoning with cyanides) and circulatory. The latter are observed in a wide variety of severe intoxications and most often manifest themselves in the form of intoxication shock. If intoxication is accompanied by hepatic or renal failure, then in the pathogenesis of myocardial dystrophy great importance acquire autointoxication, electrolyte and water imbalance; acidosis, etc.

Myocardial dystrophy in case of intoxication, it may increase as a result of increased work of the heart (with psychomotor agitation, prolonged tachycardia, increased pressure in the small or big circle blood circulation), as well as for various infectious complications, among which pneumonia occupies a prominent place.

At the heart of the pathological process With myocardial dystrophies, there is a violation of the activity of redox processes in the myocardium. The prognosis for myocardial dystrophies is largely determined by the nature of the poison, the degree of intoxication and the therapeutic measures. In some cases, myocardial dystrophy disappears within a few days after the cessation of intoxication; in others, after many weeks.

For severe intoxications In almost all cases, the cardiotoxic effect of the poison is manifested to one degree or another (for example, in case of poisoning with chlorinated hydrocarbons, vinegar essence, sleeping pills, etc.). Among the substances that can cause poisoning are pharmacological preparations, chemical compounds, animal poisons and plant origin, which have a pronounced cardiotoxic effect. Such substances include cardiac glycosides, quinine and quinidine, pachycarpine; plant alkaloids - muscarine (fly agaric mushrooms), veratrine (helebore), coniine (hemlock), aconite (Issyk-Kul root), etc. Organophosphorus compounds have a pronounced cardiotoxic effect.

In case of poisoning with cardiotoxic substances pathological process V myocardium becomes leading and is accompanied by disturbances in the rhythm, conductivity and contractility of the heart; in case of severe intoxication, sudden death may occur due to clinical picture cardiogenic shock.