Olander digoxin

Cardia-active steroids

1. Oleander
2. Yellow Oleander

MOde of Damage

1. Inhibits Na+/K+ ATPase
2. 📈 Na interacellular
3. Na/Ca pump activation
4. 📈 Ca inside cell => premature ventricular contraction , shorten the repolarization intervals of the atria and ventricles

5. with Brady vagally mediated parasympathetic tone.

6. Parasympathetic activation by increase Ca release inside Pre-ganglionic neuron = > Bradicardia

7. Sympathetic activation by Ca accumulation in Pre-ganglionic neuron
8. NA/K pump inhibtion inSK muscles => Hyperkalemia => Hyperpolarisation of COnduction system[need more juice to depolarise] => AV nodal block

Diagnosis

• ECG changes - brady -arrthymas , wide QRS complex tachycardia
• Digoxin Serum lvl
• Serum K level as indicator of Toxicity

Mng

• Serum electrolytes = from Na/K pump inhibion in skeletal muscles 👉 Hyperkalemia

mng

• recirculated enterohepatically => Multi-dose charcoal 1g/kg every 2-4 hrs of total 4 doses
• Digoxin auto antibodies