ماذا تفعل عندما يفشل الفابريجمنت المناعي للديجوكسين الأولي في حالات تسمم الديجوكسين المهدد للحياة مع السكتة القلبية

DOI: 10.1097/MEJ.0000000000001065

• Ventricular tachycardia or fibrillation
• Asystole or symptomatic, high-degree atrioventricular block
• Severe hyperkalaemia (serum potassium >6.5 mmol/L)
• Hypotension (systolic blood pressure <100 mmHg) associated with end-organ dysfunction
• The consensus expert opinion was that for patients with digoxin toxicity in cardiac arrest (loss of cardiac output due to asystole, pulseless electrical activity or tachyarrhythmias), five vials of digoxin immune Fab (40 milligrams per vial) are administered immediately.
• For patients with potentially life-threatening digoxin toxicity who are in cardiac arrest, five vials (or as many vials as available up to a maximum of five) of digoxin immune Fab (40 milligrams per vial) should be administered immediately; if an adequate clinical response is not seen after 30 min, a further five vials can be given.
• Patients should be monitored closely after administration of digoxin immune Fab, including assessment of serum potassium concentrations, body temperature, blood pressure, ECG and renal function (serum urea and creatinine and estimated glomerular filtration rate); monitoring should continue until potassium concentration, ECG and renal function are 'normalised'.