过量服用地高辛中毒

Toxication due to overdose of digoxin

1例63岁男性患者因慢性心功能不全致劳累后气喘、夜间睡眠时憋气,口服地高辛0.125 mg,1次/d。用药5 d后症状缓解,患者自行将地高辛剂量增至0.5 mg,2次/d,连续服用7 d后气喘症状较前加重,夜间睡眠不能平卧,乏力,食欲差,恶心、呕吐。心电图检查:Ⅲ度房室传导阻滞,频发室性期前收缩,呈二联律,心室率57次/min。实验室检查示血钾2.9 mmol/L;地高辛血清浓度>5.0μg/L。停用地高辛,并给予补钾等对症处理。5 d后患者症状明显缓解,心电图及血钾水平恢复正常,再次给予地高辛0.125 mg,1次/d口服。5 d后实验室检查示血钾4.2 mmol/L,地高辛血清浓度1.8μg/L,患者未再出现恶心、呕吐等不适症状。

A 63-year-old male with asthma received digoxin 0, 125 mg once daily for tiredness and short of breath during sleep due to chronic cardiac insufficiency. On day 5 of taking digoxin, his symptoms improved. The dose of digoxin was increased to 0.5 mg twice daily by himself for 7 days and the patient＇s asthma symptoms was exacerbated. He could not lie down for sleep at night and had fatigue, poor appetite, disorder of the stomach, nausea, and vomiting. Electroncardiography showed Ⅲ degree atrioventricular block, frequent premature ventricular contractions and bigeminy. The patient＇s ventricular rate was 57 beats per minute. Laboratory tests revealed the following levels： serum potassium 2.9 retool/L, digoxin plasma concentration 〉 5.0 μg/L. Digoxin was withdrawn immediately. Potassium supplement and other sympto- matic treatment were given. Five days later, his symptom was improved and the electrocardiogram and serum potassium recovered to normal. Digoxin 0. 125 mg once daily was given again. Five days later, laboratory tests revealed the following levels： serum potassium 4.3 mmol/L, digoxin plasma concentration 1.78 μg/L. The patient did not present the symptoms of nausea and vomiting again.