title: Cardiac glycoside toxicity: more than 200 years and counting.
abstract: Digitalis toxicity produces a toxidrome characterized by gastrointestinal, neurologic, electrolyte, and nonspecific cardiac manifestations. Chronic toxicity remains much more difficult to recognize compared with an acute presentation because of the nonspecific manifestations; therefore, serum glycoside levels are essential for diagnosis in this population. The mainstay of management continues to be rapid toxidrome identification followed by digoxin-specific antibody fragment therapy with supportive care. Several controversies still remain, including therapy for patients dependent on hemodialysis, appropriateness of calcium therapy for hyperkalemia, ideal agents for arrhythmia therapy, and the potential utility of plasmapheresis for removal of bound digoxin-antibody fragment complexes.
authors.affiliation: Department of Pharmacy, The Ottawa Health Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. Skanji@toh.on.ca
authors.forename: Salmaan
authors.initials: S
authors.lastname: Kanji
authors.forename: Robert D
authors.initials: RD
authors.lastname: MacLean
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000506:poisoning*; D000931:Antidotes / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000188:drug therapy; D004071:Digitalis Glycosides / Q000494:pharmacology / Q000506:poisoning*; D004077:Digoxin / Q000097:blood; D062787:Drug Overdose / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced
chemical_list: D000889:Anti-Arrhythmia Agents; D000931:Antidotes; D004071:Digitalis Glycosides; D004077:Digoxin