Digoxin 25.9 mg/dl Cr 0.9 mg/dl T μg/dl TSH μ IU/mL digoxin 2.67 ng/ml ( ) digoxin digoxin lidocaine (2% 5cc) polystyrene sulfonat (9% 5

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1 Digoxin 中毒之案例討論彰化基督教醫院二林分院藥劑課藥師洪世蓉洪慈徽澄清醫院中港分院藥劑部藥師洪世芬台中榮民總醫院藥劑部藥師洪世芳摘要 Digoxin (cardiac glycoside) (therapeutic window) Digoxin digoxin digoxin 壹前言 D i g o x i n ( c a r d i a c glycoside) Na + -K + -ATPase (congestive heart failure CHF) 1 Digoxin (therapeutic window) ng/mL ( ) ( ) 2 Digoxin 3 digoxin digoxin 貳案例報告 (bradycardia) ( ) digoxin aldactone K 6.3 meq/l Na 95 meq /L BUN 60 THE JOURNAL OF TAIWAN PHARMACY Vol.27 No.4 Dec

2 Digoxin 25.9 mg/dl Cr 0.9 mg/dl T μg/dl TSH μ IU/mL digoxin 2.67 ng/ml ( ) digoxin digoxin lidocaine (2% 5cc) polystyrene sulfonat (9% 5 g) 4 pkg tid 3% NaCl 5/26 5/27 5/29 5/30 表一住院前長期門診用藥 Digoxin 0.25 mg 0.5 tab QD Aldactone 25 mg 1 tab BID Gascon 40 mg 1 tab TID Emetrol 10 mg 1 tab TID Speedon powder 10 g/pkg 1 pkg BID 表二檢驗數值 5/18 5/19 5/20 5/21 5/25 BUN (mg/dl) Cr (mg/dl) Na (meq/l) K (meq/l) Digoxin (ng/ml) T4 ( g/dl) TSH ( IU/mL) Cortisol AM ( g/dl) Cortisol PM ( g/dl) 表三住院期間用藥紀錄 Drug/Date 5/18 5/19 5/20 5/21 5/22 5/23 5/24 5/25 5/26 5/27 5/28 5/29 5/30 5/31 6/1 6/2 Dobutamin (250 mg) 2 vail qd 4vial qd Dopamin (200 mg) 4 amp qd Meropenem (500 mg) 2 vial q12h Sodium chloride (3%500 cc) 1 btl st Sodium chloride (0.45%500 cc) 1 btl qd Sodium chloride (0.9%500 cc) 1 btl qd 2 btl st 2 btl st Polystyrene sulfonat (9%5 g) 4 pkg tid 1 pkg tid MgO (250 mg) 2 # tid 7D Sennoside (12 mg) 2 # hs 7D Lidocaine (2%5 cc) 1 amp st Sodium chloride (0.9%500 cc) 2 btl st Acetaminophen (500 mg) prn 1#ASO Albumin (20%50 cc) 2 btl qd Furosemide (20 mg) 1 amp qd Metoclopramide (10 mg) 1 amp q8h Clopidogrel (75 mg) 1# qd 27 4 Dec 藥學雜誌第 109 冊 61

3 Bisacodyl supp (10 mg) 2 supp Isomol (20 mg) D Domperidone (10 mg) 1# qd 7D Epinephrine (1 mg) 1 amp st Aspirin (100 mg) 1# qd 7D Ceftibuten (100 mg) 2# bid 7D 參討論 Digoxin digoxin 5-15% 2 digoxin digoxin digoxin digoxin Digoxin 3 (1) (anorexia) digoxin 2 (2) ( ) 4 (3) AV nodal block bradycardia VPC (4) digoxin digoxin digoxin 2.67 ng/ml (>2.4 ng/ ml) digoxin 一 Digoxin 中毒的治療是依據臨床症狀 1. digoxin 5 2. digoxin 1 3. ( ) ( ) 6 (1) (bradycardia) (A) Atropine mg 7 ( B ) bradycardia atropine ( t e m p o r a r y transvenous pacing (C) (sympathominetics) 2 (2) (ventricular dysrhythmia) (A) Phenytion 15 mg/ kg ( 1.0 g) ( 0.5 mg/kg/ min) 12 2 mg/kg mg/ml 6 (B) 62 THE JOURNAL OF TAIWAN PHARMACY Vol.27 No.4 Dec

4 Digoxin Lidocaine mg/kg mg/kg 3mg/kg 7 (C) Magnesium sulfate 2 g g/hour 5 4 meq/liter 8 (D) quinidine digoxin quinidine digoxin 9 (E) (1) ( ) 2 (2) ( AV block)3 (3) (A) Kayexalate ( ) 1 g meq K + Na + Na + (100 mg/1 g Kayexalate) (B) Insulin/glucose K + K iu regular insulin +50 % glucose 50 ml D10W 50 ml/hr 6 (C) 1.0 meq/kg 6 (3) ATPase (4) EDTA Ca 2+ digoxin 1 7. d i g o x i n digoxin-specific antibody ( Fab fragment) (1) (A) ( ) 6 (B) 5.5 mmol/l 6 (2) Fab fragment (3) Fab fragment 6 (4) (A) Digibind ( 0.5 mg digoxin/38 mg digoxin specific Fab/vial) (a) Digibind 10 vial 2-6 vial ( 1 vial) IV 30 min (b) digoxin (mg) 0.8 (0.8 digoxin ) 0.5 mg = Digibind (c) Serum digoxin level (ng/ml) (Kg) 100 Digibind (B) Digitalis antidote BM ( 1 mg digoxin/80 mg digoxin specific Fab/vial) Digibind 6 (5) Fab fragment digoxin free (unbound) digoxin 2 bradycardia digoxin digoxin lidocaine (2%5 cc) dobutamin dopamine ( Isomol ) polystyrene sulfonat (9% 5 g) 4 pkg tid 3% NaCl 27 4 Dec 藥學雜誌第 109 冊 63

5 aldactone furosemide 肆討論 Digoxin digoxin digoxin ( ) ( ) digoxin digoxin digoxin 參考資料 : F.I. Marcus, L.H. Opie, E.H. Sonnenblick: Digitalis and Other Inotropes. In:Lionel H. Opie, M.D., D.Phil. et al: DRUGS for the HEART, 3rd ed. Philadelphia, W.B.Saunders,1991: Braunwald E: Heart Failure. In: Kurt J.Isselbacher, Eugene Braunwald, Jean D.Wilson et al:harrison's Principles of Internal Medicine Companion, 13th ed. New York. McGraw-Hill,1995: Paul L. Marino: The ICU Book, 3rd ed. Philadelphia, Lippincott Williams & Wilkins, 2007:283-86, 620, W. Brian Gibler: Antiarrhythmics. William G. Barsan, Michael S. Jastremski, Scott A. Syverud.,Emergency Drug Therapy 1st ed. Philadelphia, W.B.Saunders,1991: Louis J.Ling: Antidotes. William G. Barsan, Michael S. Jastremski, Scott A. Syverud.,Emergency Drug Therapy 1st ed. Philadelphia, W.B.Saunders,1991: A Case Report on Digoxin Overdose Shih-Rong Hong 1, Cih-Huei Hong 1, Shih-Fen Hong 2, Shih-Fang Hong 3 Department of Pharmacy, Erlin Branch of Changhua Christian Hospital 1, Department of Pharmacy, Chung Kang Branch of Cheng Ching General Hospital 2, Department of Pharmacy, Taichung Veterans General Hospital 3 Abstract Digoxin is a cardiac glycoside, its therapeutic window is narrow, and it is still for something to be toxic. It should be judged by the clinical manifestation. Treatment of digoxin toxicity almost depends on the clinical severity. This article is talking about how to diagnose whether it is digoxin poisoning, and the treatment after diagnosis for a case to provide medical professional references. 64 THE JOURNAL OF TAIWAN PHARMACY Vol.27 No.4 Dec

middle cerebral artery infarct) 16:43 rt-pa 5 mg 1 41 mg (muscle power, MP) (right middle cerebral artery infarct) diltiazem 15 mg TID PO 10

middle cerebral artery infarct) 16:43 rt-pa 5 mg 1 41 mg (muscle power, MP) (right middle cerebral artery infarct) diltiazem 15 mg TID PO 10 臨床藥物治療學缺血性腦中風的治療之案例報告中國醫藥大學藥學系江尚德台大醫院雲林分院藥劑部藥師張有邑莊謹如廖玲巧摘要 (recombinant tissue plasminogen activator, rt-pa) rt-pa rt-pa 壹前言 (7.3 %) (29.0 %) (11.5%) 1 67.9 % 2 (recombinant tissue plasminogen activator,