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Article
January 1968

Digitalis Tolerance During Septic Shock

Author Affiliations

Durham, NC
From the Department of Surgery, Duke University Medical Center, Durham, NC. Dr. Allgood is now at the Department of Surgery, University of Oklahoma Medical Center, Oklahoma City.

Arch Surg. 1968;96(1):91-94. doi:10.1001/archsurg.1968.01330190093021
Abstract

DIGITALIS preparations are recommended in treatment of shock because cardiac failure has been shown to occur in the late stages.1-3 It has been advocated as a general supportive measure since digitalis is known to improve contractility of the normal as well as the failing heart.4,5 Wiggers6 states that as many as 80% of patients in shock develop myocardial failure. Though the basis for administration of digitalis appears sound, little is known regarding dosage toxicity relationships during shock.7 In the present study the tolerance of the heart to acetyl strophanthidin was determined in the normal state and during endotoxin shock.

Methods  Mongrel dogs (10 to 20 kg) were anesthetized with intravenous pentobarbital (30 mg/kg) and ventilation maintained with a mechanical respirator using room air. Lead II of the electrocardiogram was continuously monitored and periodic segments recorded. An intravenous catheter was placed in a peripheral vein and acetyl

References
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Braunwald, E., et al:  Studies on Digitalis: IV. Observations in Man on the Effects of Digitalis Preparations on the Contractility of the Nonfailing Heart and on Total Vascular Resistance , J Clin Invest 40:52, 1961.Article
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Wiggers, C.J.: Physiology of Shock , New York: Commonwealth Fund, 1950.
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Austen, W.G., et al:  The Effect of Cardiopulmonary Bypass on Tissue Digoxin Concentrations in the Dog , J Surg Res 2:85, 1962.Article
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Solis, R.T., and Downing, W.E.:  Effects of E coli Endotoxemia on Ventricular Performance: Responses to Angiotensin II and Isoproterenol, abstracted , Clin Res 11:396, 1963.
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Guyton, A.C.: Circulatory Physiology: Cardiac Output and Its Regulation , Philadelphia: W. B. Saunders Co., 1963.
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Bliss, H.A.; Fishman, N.E.; and Smith, P.M.:  Effect of Alternation of Blood pH on Digitalis Toxicity , J Lab Clin Med 62:53, 1963.
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Marshall, R.J., and Darby, T.J.: Shock , Springfield, Ill: Charles C Thomas, Publishers, 1966.
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Crowell, J.W., and Guyton, A.C.:  Cardiac Deterioration in Shock: II. Irreversible Stage , Int Anesth Clin 2:171, 1964.Article
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Thal, A.P., and Wilson, R.F.:  Shock , Curr Probl Surg , (Sept) 1965, pp 1-62.
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Halmagyi, D.F.J.; Starzelki, B.; and Homer, G.J.:  Mechanism and Pharmacology of Endotoxin Shock in Sheep , J Appl Physiol 18:544, 1963.
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