Digitialis
-for rx svt's and chf
-in foxglove, oleander, lily of the valley
-poisons na-k atpase pump -> inc sarco ca + inc extracell K -> inc vagal tone and dec cond AV node
si/sx
-acute od - n/v, bradydys, svt dys with av block, vent dys
-chronic tox - elderly on diuretics; GI sx, weakness, yellow-green halos, syncope, ams, hallucinations, szs, vent dys
-inc risk incl elderly, copd, ht, renal dis, hypokal
labs:
-therapeutic dig level is .5 to 2.0 ng/ml; levels most reliable 6 hr p ingest; chronic tox levels may be low-norm
-lytes for k level
Rx
-vitals, o2, monitor, iv
-act charcoal 1g/kg then .5 g/kg q 4-6h
-bradydys - atropine .5-2.0 mg iv/pacing
-vent dys - phenytoin 15mg/kg iv, no faster than 25 mg/min infusion; lidocaine 1mg/kg iv; mgso4 2-4g iv; cardioversion 10-25 w/s for refractory vent dys (last resort)
-hyperkal - glc + insulin, bicarb, resin, HD; avoid calcium chloride
-dig-specific Fab - indications vent dys, bradydys w/hypotn, hyperkalemia >5.5
Dispo
-asx after 12 hrs of obs
-given fab - icu setting
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