Visual Manifestations of Digitalis Poisoning

The efficacy profile of lidocaine as a local anesthetic is characterized by a rapid onset of action and an intermediate duration of efficacy. Therefore, lidocaine is suitable for infiltration, block, and surface anesthesia. Longer-acting substances such as bupivacaine are sometimes given preference for spinal and peridural anesthesias, however, lidocaine, on the other hand, has the advantage of a rapid onset of action. Adrenaline supplements could delay the resorption and the duration of efficacy could be doubled. Lidocaine is the most important class 1B antiarrhythmic drug: it is used intravenously for the treatment of ventricular arrhythmias (for acute myocardial infarction, digitalis poisoning, cardioversion, or cardiac catheterization). However, a routine prophylactic administration is no longer recommended for acute cardiac infarction. The overall benefit of this measure is not convincing. Lidocaine has also been efficient in refractory cases of status epilepticus.

Download Full-text

Fab Fragments of Digoxin-Specific Antibodies Used to Reverse Ventricular Fibrillation Induced by Digoxin Ingestion in a Child

PEDIATRICS ◽

10.1542/peds.70.3.468 ◽

1982 ◽

Vol 70 (3) ◽

pp. 468-471

Author(s):

Aaron R. Zucker ◽

Samuel J. Lacina ◽

D. S. DasGupta ◽

H. A. Fozzard ◽

David Mehlman ◽

...

Keyword(s):

Ventricular Fibrillation ◽

Digoxin Level ◽

Bundle Branch Block ◽

Specific Antibodies ◽

Fab Fragments ◽

Intellectual Function ◽

Digitalis Poisoning ◽

Life Saving ◽

Life Threatening ◽

Massive Overdose

Digitalis poisoning is a rare problem in children, but it may be life threatening. A case of massive overdose of digoxin in a 2½-year-old boy that produced prolonged ventricular fibrillation refractory to conventional therapy is reported. After two hours the boy was given digoxin-specific Fab fragments of antibody in sufficient quantity to bind his estimated dose of 10 mg. By completion of the treatment minutes later, normal rhythm and circulation were restored. The serum free digoxin level before antibody administration was > 100 ng/ml, and it rapidly fell to undetectable levels after antibody was given. Digoxin bound to the antibody had a clearance half-life of approximately 48 hours. The child had no apparent neurologic damage and his intellectual function was normal on discharge. He had a transient hematuria and a residual incomplete right bundle branch block. Administration of purified Fab fragments of digoxin-specific antibodies can be life saving in children with digitalis poisoning, and prolonged cardiopulmonary resuscitation in children is justified when the cause of cardiac arrest is potentially reversible.

Download Full-text