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55-648: It is used for digoxin toxicity . Digoxin toxicity can emerge during long-term therapy as well as after an overdose. It can occur even when the serum digoxin concentration is within the therapeutic range when one of the following is present: Side effects of digoxin immune fab may occur: Avoid use in hypokalemia as this drug, while reversing the effects of digitalis , will further reduce serum potassium levels and could precipitate dangerous and even fatal cardiac arrhythmias . The patient must be closely monitored for anaphylactic shock , and anyone allergic to sheep protein, papain , bromelain , or papaya extracts (papain

110-478: A poison is a substance that obstructs or inhibits a nuclear reaction. Environmentally hazardous substances are not necessarily poisons, and vice versa. For example, food-industry wastewater—which may contain potato juice or milk—can be hazardous to the ecosystems of streams and rivers by consuming oxygen and causing eutrophication , but is nonhazardous to humans and not classified as a poison. Biologically speaking, any substance, if given in large enough amounts,

165-1234: A bite or sting through a venom apparatus , such as fangs or a stinger , in a process called envenomation , whereas poisons are toxins that are passively delivered by being swallowed, inhaled, or absorbed through the skin. Unantidoteable refers to toxins that cannot be neutralized by modern medical technology, regardless of their type. Industry , agriculture , and other sectors employ many poisonous substances, usually for reasons other than their toxicity to humans. (e.g. feeding chickens arsenic antihelminths ), solvents (e.g. rubbing alcohol, turpentine), cleaners (e.g. bleach, ammonia), coatings (e.g. Arsenic wallpaper), and so on. For example, many poisons are important feedstocks . The toxicity itself sometimes has economic value, when it serves agricultural purposes of weed control and pest control . Most poisonous industrial compounds have associated material safety data sheets and are classified as hazardous substances . Hazardous substances are subject to extensive regulation on production, procurement, and use in overlapping domains of occupational safety and health , public health , drinking water quality standards , air pollution , and environmental protection . Due to

220-441: A broad sense. Whether something is considered a poison or not may depend on the amount, the circumstances, and what living things are present. Poisoning could be accidental or deliberate, and if the cause can be identified there may be ways to neutralise the effects or minimise the symptoms . In biology , a poison is a chemical substance causing death , injury or harm to organisms or their parts. In medicine , poisons are

275-453: A chemical defense developed by Theobroma cacao can be incidentally fatal nevertheless. Many omnivores, including humans, readily consume edible fungi , and thus many fungi have evolved to become decisively inedible , in this case as a direct defense. Chronic poisoning is long-term repeated or continuous exposure to a poison where symptoms do not occur immediately or after each exposure. The person gradually becomes ill, or becomes ill after

330-495: A higher mortality (7.6%) was noted in a case series of acute and chronic digoxin and digitoxin poisoning despite Fab being used first line. Further, a retrospective case‐controlled study of chronic digoxin poisoning did not observe a beneficial effect of anti‐digoxin Fab on mortality. An RCT (n = 66) in yellow oleander poisoning showed an early improvement in cardiac rhythm and hyperkalaemia from anti‐digoxin Fab, prompting early termination of

385-620: A kind of toxin that are delivered passively, not actively. In industry the term may be negative, something to be removed to make a thing safe, or positive, an agent to limit unwanted pests . In ecological terms , poisons introduced into the environment can later cause unwanted effects elsewhere, or in other parts of the food chain . In broad metaphorical (colloquial) usage of the term, "poison" may refer to anything deemed harmful. In biology , poisons are substances that can cause death , injury, or harm to organs , tissues , cells , and DNA usually by chemical reactions or other activity on

440-919: A long latent period. Chronic poisoning most commonly occurs following exposure to poisons that bioaccumulate , or are biomagnified , such as mercury , gadolinium , and lead . In 2010, poisoning resulted in about 180,000 deaths down from 200,000 in 1990. There were approximately 727,500 emergency department visits in the United States involving poisonings—3.3% of all injury-related encounters. Poisonous compounds may be useful either for their toxicity, or, more often, because of another chemical property, such as specific chemical reactivity. Poisons are widely used in industry and agriculture, as chemical reagents, solvents or complexing reagents, e.g. carbon monoxide , methanol and sodium cyanide , respectively. They are less common in household use, with occasional exceptions such as ammonia and methanol . For instance, phosgene

495-447: A poison as such, but to turn the body's natural defenses against itself. Poison can also enter the body through faulty medical implants , or by injection (which is the basis of lethal injection in the context of capital punishment ). In 2013, 3.3 million cases of unintentional human poisonings occurred. This resulted in 98,000 deaths worldwide, down from 120,000 deaths in 1990. In modern society, cases of suspicious death elicit

550-451: A primary food source. Selective toxicity, controlled application, and controlled biodegradation are major challenges in herbicide and pesticide development and in chemical engineering generally, as all lifeforms on earth share an underlying biochemistry ; organisms exceptional in their environmental resilience are classified as extremophiles , these for the most part exhibiting radically different susceptibilities. A poison which enters

605-423: A result of decreased usage of digoxin. In the United States 2500 cases were reported in 2011 which resulted in 27 deaths. The condition was first described in 1785 by William Withering . Digoxin toxicity is often divided into acute or chronic toxicity. In both of these toxicity, cardiac effects are of the greatest concern. With an acute ingestion, symptoms such as nausea, vertigo , and vomiting are prominent. On

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660-569: A serum digoxin concentration, serum potassium concentration, creatinine, BUN, and serial electrocardiograms is obtained. In digoxin toxicity, the finding of frequent premature ventricular beats (PVCs) is the most common and the earliest dysrhythmia. Sinus bradycardia is also very common. In addition, depressed conduction is a predominant feature of digoxin toxicity. Other ECG changes that suggest digoxin toxicity include bigeminal and trigeminal rhythms, ventricular bigeminy, and bidirectional ventricular tachycardia. The level of digoxin for treatment

715-595: A variety of natural or synthetic substances. Substances that destroy tissue but do not absorb, such as lye , are classified as corrosives rather than poisons. Acute poisoning is exposure to a poison on one occasion or during a short period of time. Symptoms develop in close relation to the exposure. Absorption of a poison is necessary for systemic poisoning. Furthermore, many common household medications are not labeled with skull and crossbones, although they can cause severe illness or even death. Poisoning can be caused by excessive consumption of generally safe substances, as in

770-691: Is a highly reactive nucleophile acceptor, which makes it an excellent reagent for polymerizing diols and diamines to produce polycarbonate and polyurethane plastics. For this use, millions of tons are produced annually. However, the same reactivity makes it also highly reactive towards proteins in human tissue and thus highly toxic. In fact, phosgene has been used as a chemical weapon . It can be contrasted with mustard gas , which has only been produced for chemical weapons uses, as it has no particular industrial use. Biocides need not be poisonous to humans, because they can target metabolic pathways absent in humans, leaving only incidental toxicity. For instance,

825-476: Is a medication used for heart failure or atrial fibrillation . An electrocardiogram is a routine part of diagnosis. Blood levels are only useful more than six hours following the last dose. Activated charcoal may be used if it can be given within two hours of the person taking the medication. Atropine may be used if the heart rate is slow while magnesium sulfate may be used in those with premature ventricular contractions . Treatment of severe toxicity

880-641: Is also distinct from toxicity itself. For instance, the preservative thiomersal used in vaccines is toxic, but the quantity administered in a single shot is negligible. Throughout human history, intentional application of poison has been used as a method of murder , pest-control , suicide , and execution . As a method of execution, poison has been ingested, as the ancient Athenians did (see Socrates ), inhaled, as with carbon monoxide or hydrogen cyanide (see gas chamber ), injected (see lethal injection ), or even as an enema . Poison's lethal effect can be combined with its allegedly magical powers; an example

935-400: Is any poison produced by an organism, such as the bacterial proteins that cause tetanus and botulism . A distinction between the two terms is not always observed, even among scientists. The derivative forms "toxic" and "poisonous" are synonymous. Animal poisons delivered subcutaneously (e.g., by sting or bite ) are also called venom . In normal usage, a poisonous organism is one that

990-496: Is based on the amount of digoxin ingested whereas the second method is based on the serum digoxin concentration and the weight of the person. Other treatment that may be used to treat life-threatening arrhythmias until Fab is acquired are magnesium , phenytoin , and lidocaine . Magnesium suppresses digoxin-induced ventricular arrhythmias while phenytoin and lidocaine suppresses digoxin-induced ventricular automaticity and delay afterdepolarizations without depressing AV conduction. In

1045-527: Is chemically converted to toxic formaldehyde and formic acid in the liver . Many drug molecules are made toxic in the liver, and the genetic variability of certain liver enzymes makes the toxicity of many compounds differ between individuals. Exposure to radioactive substances can produce radiation poisoning , an unrelated phenomenon. Two common cases of acute natural poisoning are theobromine poisoning of dogs and cats , and mushroom poisoning in humans. Dogs and cats are not natural herbivores, but

1100-411: Is harmful to consume, but a venomous organism uses venom to kill its prey or defend itself while still alive. A single organism can be both poisonous and venomous, but it is rare. All living things produce substances to protect them from getting eaten, so the term "poison" is usually only used for substances which are poisonous to humans, while substances that mainly are poisonous to a common pathogen to

1155-434: Is intended for intravenous administration. Digibind is manufactured by GlaxoSmithkline, SpA, Parma Italy under US License No. 129. It’s distributed by GSK, Research Triangle park, NC 27709. A patent to use digoxin immunoglobulins C07k16/44 as a regulator of the preeclamptic/eclamptic patient's sodium/potassium ATPase activity was approved in 2003 to Charles David Adair under application number WO2004011028A1. Price increase

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1210-471: Is poisonous and can cause death. For instance, several kilograms worth of water would constitute a lethal dose . Many substances used as medications—such as fentanyl —have an LD 50 only one order of magnitude greater than the ED50 . An alternative classification distinguishes between lethal substances that provide a therapeutic value and those that do not. Poisoning can be either acute or chronic, and caused by

1265-515: Is the Chinese gu poison . Poison was also employed in gunpowder warfare . For example, the 14th-century Chinese text of the Huolongjing written by Jiao Yu outlined the use of a poisonous gunpowder mixture to fill cast iron grenade bombs. While arsenic is a naturally occurring environmental poison, its artificial concentrate was once nicknamed inheritance powder . In Medieval Europe, it

1320-414: Is their toxicity to various insects and other animals deemed to be pests (e.g., rats and cockroaches ). Natural pesticides have been used for this purpose for thousands of years (e.g. concentrated table salt is toxic to many slugs and snails ). Bioaccumulation of chemically-prepared agricultural insecticides is a matter of concern for the many species, especially birds , which consume insects as

1375-416: Is typically 0.5-2 ng/mL. Since this is a narrow therapeutic index , digoxin overdose can happen. A serum digoxin concentration of 0.5-0.9 ng/mL among those with heart failure is associated with reduced heart failure deaths and hospitalizations. It is therefore recommended that digoxin concentration be maintained in approximately this range if it is used in heart failure patients. High amounts of

1430-435: Is used to cleave the antibody into Fab and Fc fragments) should not use ovine digoxin immune fab. Because it is relatively new, no drug interaction studies have been performed yet. It works by binding to the digoxin, rendering it unable to bind to its action sites on target cells. The complexes accumulate in the blood and are expelled by the kidney. Case series have reported benefits from anti‐digoxin Fab, but data regarding

1485-409: Is with digoxin-specific antibody fragments . Its use is recommended in those who have a serious dysrhythmia, are in cardiac arrest , or have a potassium of greater than 5 mmol/L. Low blood potassium or magnesium should also be corrected. Toxicity may reoccur within a few days after treatment. In Australia in 2012 there were about 140 documented cases. This is a decrease by half since 1994 as

1540-656: The electrolyte potassium (K+) in the blood (hyperkalemia) is characteristic of digoxin toxicity. Digoxin toxicity increases in individuals who have kidney impairment. This is most often seen in elderly or those with chronic kidney disease or end-stage kidney disease . The primary treatment of digoxin toxicity is digoxin immune fab , which is an antibody made up of anti-digoxin immunoglobulin fragments. This antidote has been shown to be highly effective in treating life-threatening signs of digoxin toxicity such as hyperkalemia, hemodynamic instability, and arrhythmias. Fab dose can be determined by two different methods. First method

1595-523: The enzymes in mitochondria that make ATP . Intravenous injection of an unnaturally high concentration of potassium chloride , such as in the execution of prisoners in parts of the United States, quickly stops the heart by eliminating the cell potential necessary for muscle contraction . Most biocides, including pesticides , are created to act as acute poisons to target organisms, although acute or less observable chronic poisoning can also occur in non-target organisms ( secondary poisoning ), including

1650-488: The food chain —whether of industrial, agricultural, or natural origin—might not be immediately toxic to the first organism that ingests the toxin, but can become further concentrated in predatory organisms further up the food chain, particularly carnivores and omnivores , especially concerning fat soluble poisons which tend to become stored in biological tissue rather than excreted in urine or other water-based effluents . Apart from food, many poisons readily enter

1705-422: The humans who apply the biocides and other beneficial organisms . For example, the herbicide 2,4-D imitates the action of a plant hormone, which makes its lethal toxicity specific to plants. Indeed, 2,4-D is not a poison, but classified as "harmful" (EU). Many substances regarded as poisons are toxic only indirectly, by toxication . An example is "wood alcohol" or methanol , which is not poisonous itself, but

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1760-446: The molecular scale, when an organism is exposed to a sufficient quantity. Medicinal fields (particularly veterinary medicine ) and zoology often distinguish poisons from toxins and venoms . Both poisons and venoms are toxins, which are toxicants produced by organisms in nature. The difference between venom and poison is the delivery method of the toxin. Venoms are toxins that are actively delivered by being injected via

1815-611: The placenta during gestation, or through breast milk during nursing . In contrast, radiological damage can be passed from mother or father to offspring through genetic mutation , which—if not fatal in miscarriage or childhood , or a direct cause of infertility —can then be passed along again to a subsequent generation. Atmospheric radon is a natural radiological poison of increasing impact since humans moved from hunter-gatherer lifestyles and cave dwelling to increasingly enclosed structures able to contain radon in dangerous concentrations. The 2006 poisoning of Alexander Litvinenko

1870-435: The 18th century. The term " poison ivy ", for example, was first used in 1784 and the term " poison oak " was first used in 1743. The term " poison gas " was first used in 1915. The term "poison" is often used colloquially to describe any harmful substance—particularly corrosive substances, carcinogens , mutagens , teratogens and harmful pollutants , and to exaggerate the dangers of chemicals. Paracelsus (1493–1541),

1925-511: The AWP of DigiFab increases by 15% to US $ 903 per 40 mg vial. AWP of DigiFab has continued to increase as much as 54% occurring in March 2014 to US $ 2,370 per 40 mg vial. However, the cost may vary depending on wholesaler contractor manufacturer rebates. Digoxin toxicity Digoxin toxicity , also known as digoxin poisoning , is a type of poisoning that occurs in people who take too much of

1980-473: The English term comes from the "...Old French poison, puison (12c., Modern French poison) "a drink", especially a medical drink, later "a (magic) potion, poisonous drink" (14c.), from Latin potionem (nominative potio) "a drinking, a drink", also "poisonous drink" (Cicero), from potare "to drink". The use of "poison" as an adjective ("poisonous") dates from the 1520s. Using the word "poison" with plant names dates from

2035-515: The attention of the Coroner 's office and forensic investigators . Of increasing concern since the isolation of natural radium by Marie and Pierre Curie in 1898—and the subsequent advent of nuclear physics and nuclear technologies—are radiological poisons . These are associated with ionizing radiation , a mode of toxicity quite distinct from chemically active poisons. In mammals , chemical poisons are often passed from mother to offspring through

2090-424: The body through the skin and lungs . Hydrofluoric acid is a notorious contact poison, in addition to its corrosive damage. Naturally occurring sour gas is a fast-acting atmospheric poison, which can be released by volcanic activity or drilling rigs . Plant-based contact irritants, such as that possessed by poison ivy , are often classed as allergens rather than poisons; the effect of an allergen being not

2145-410: The case of water intoxication . Agents that act on the nervous system can paralyze in seconds or less, and include both biologically derived neurotoxins and so-called nerve gases , which may be synthesized for warfare or industry. Inhaled or ingested cyanide , used as a method of execution in gas chambers , or as a suicide method , almost instantly starves the body of energy by inhibiting

2200-462: The case of an abnormally slow heart rate (bradyarrhythmias), Atropine , catecholamines ( isoprenaline or salbutamol ), and/or temporary cardiac pacing can be used. Poison#Poisoning A poison is any chemical substance that is harmful or lethal to living organisms . The term is used in a wide range of scientific fields and industries, where it is often specifically defined. It may also be applied colloquially or figuratively, with

2255-424: The drug-antibody complexes are cleared from the circulation. DigiFab is used as an antidote to treat a life-threatening overdose of digoxin or digitoxin . DigiFab is manufactured and distributed by BTG international Inc. under U.S. License No. 186. DigiFab is a sterile, lyophilized preparation of digoxin-immune ovine Fab (monovalent) immunoglobulin fragments. It is prepared by isolating the immunoglobulin fraction of

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2310-470: The father of toxicology , once wrote: "Everything is poison, there is poison in everything. Only the dose makes a thing not a poison " (see median lethal dose ). The term "poison" is also used in a figurative sense: "His brother's presence poisoned the atmosphere at the party". The law defines "poison" more strictly. Substances not legally required to carry the label "poison" can also cause a medical condition of poisoning. Some poisons are also toxins, which

2365-434: The herbicide 2,4-dichlorophenoxyacetic acid is a mimic of a plant growth hormone, which causes uncontrollable growth leading to the death of the plant. Humans and animals, lacking this hormone and its receptor, are unaffected by this, and need to ingest relatively large doses before any toxicity appears. Human toxicity is, however, hard to avoid with pesticides targeting mammals, such as rodenticides . The risk from toxicity

2420-544: The inotropic effects of digoxin could develop heart failure and hypokalaemia could result within 1–5 hours, owing to intracellular shifts of potassium, as the effects of digoxin are reversed. Patients who require redigitalization must wait for the complexes to be eliminated from the body by the kidneys, this taking 2–3 days with normal renal function. Unfortunately, fab fragments interfere with both fluorescence excitation transfer immunoassays and radioimmunoassays for digoxin. This means that serum drug levels cannot be monitored until

2475-557: The mechanics of molecular diffusion , many poisonous compounds rapidly diffuse into biological tissues , air, water, or soil on a molecular scale. By the principle of entropy , chemical contamination is typically costly or infeasible to reverse, unless specific chelating agents or micro-filtration processes are available. Chelating agents are often broader in scope than the acute target, and therefore their ingestion necessitates careful medical or veterinarian supervision. Pesticides are one group of substances whose prime purpose

2530-554: The medication digoxin or eat plants such as foxglove that contain a similar substance. Symptoms are typically vague. They may include vomiting, loss of appetite, confusion , blurred vision, changes in color perception, and decreased energy. Potential complications include an irregular heartbeat , which can be either too fast or too slow . Toxicity may occur over a short period of time following an overdose or gradually during long-term treatment. Risk factors include low potassium , low magnesium , and high calcium . Digoxin

2585-415: The organism and humans are considered antibiotics . Bacteria are for example a common adversary for Penicillium chrysogenum mold and humans, and since the mold's poison only targets bacteria, humans use it for getting rid of it in their bodies. Human antimicrobial peptides which are toxic to viruses, fungi, bacteria, and cancerous cells are considered a part of the immune system. In nuclear physics ,

2640-532: The other hand, nonspecific symptoms are predominant in chronic toxicity. These symptoms include fatigue, malaise, and visual disturbances. The classic features of digoxin toxicity are nausea, vomiting, abdominal pain, headache, dizziness, confusion, delirium, vision disturbance (blurred or yellow vision ). It is also associated with cardiac disturbances including irregular heartbeat , ventricular tachycardia , ventricular fibrillation , sinoatrial block and AV block . In individuals with suspected digoxin toxicity,

2695-454: The ovine serum, digesting it with papain and isolating the digoxin-specific Fab fragments by affinity chromatography. These antibody fragments have a molecular weight of approximately 46,000 Da. Each vial of DigiFab, which will bind approximately 0.5 mg digoxin, contains 40 mg of digoxin immune Fab, 75 mg (approx) of mannitol USP, and 2 mg (approx) sodium acetate USP as a buffering agent. The product contains no preservatives and

2750-431: The prior ecology (especially if the prior ecology was associated with human economic value or an established industry such as shellfish harvesting). The scientific disciplines of ecology and environmental resource management study the environmental life cycle of toxic compounds and their complex, diffuse, and highly interrelated effects. The word "poison" was first used in 1200 to mean "a deadly potion or substance";

2805-523: The response in acute or chronic poisoning are conflicting. Recent observational data support an effect in acute poisoning, but efficacy in chronic poisoning be minimally effective in alleviating cardiac toxicities in chronic digoxin poisoning. Data also support outcomes of acute digoxin poisoning without use of anti‐digoxin Fab. A case series of 147 patients showed that not all cases of acute digoxin overdose require anti‐digoxin Fab, nor should anti‐digoxin Fab dose be calculated based on ingested dose. In contrast,

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2860-443: The trial. It was not powered to detect a change in mortality and no deaths were noted. As with all foreign proteins, anaphylaxis, serum sickness or febrile reactions are a source of concern, especially with repeated administration. These reactions appear uncommon for example, in a study of 717 adults where only six patients (0.8%) exhibited any evidence of allergic response. Nevertheless, theoretically, patients previously dependent upon

2915-437: Was a notable use of radiological assassination, presumably meant to evade the normal investigation of chemical poisons. Poisons widely dispersed into the environment are known as pollution . These are often of human origin , but pollution can also include unwanted biological processes such as toxic red tide , or acute changes to the natural chemical environment attributed to invasive species , which are toxic or detrimental to

2970-594: Was common for monarchs to employ personal food tasters to thwart royal assassination , in the dawning age of the Apothecary . The term poison is also used in a figurative sense. The slang sense of alcoholic drink is first attested 1805, American English (e.g., a bartender might ask a customer "what's your poison?" or "Pick your poison"). Figurative use of the term dates from the late 15th century. Figuratively referring to persons as poison dates from 1910. The figurative term poison-pen letter became well known in 1913 by

3025-445: Was reported to range from US $ 380 to US $ 750 during 2013 for digoxin-Fab. However, these price increases are not reflective of the United States average AWP for digoxin-Fab as it represents Australian costs converted to US. Prior to 2011, Digibind and DigiFab pricing was US $ 797 per 38 mg vial and US $ 786 per 40 mg vial respectively. After GSK discontinued Digibind sale in USA in 2011,

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