(5) In cases of sudden collapse due to organic lesions or acute secondary weakness of the heart.
(6) In cases where operations along the gastro-intestinal tract or upper respiratory tract makes the oral or rectal administration of digitalis inadvisable.
(7) In certain cases of arteriosclerosis the stomach distends on the slightest intoxication. In such cases the intravenous route is of great value.
(8) In traumatic shock with tachycardia and low arterial pressure the intravenous route is the one of choice.
(9) It is also indicated in the beginning of the treatment of an ordinary right asystole. When the peripheral ad visceral barriers have been overcome by pleural puncture, puncture of the ascites, purgation and reduction of fluid by a restricted diet and fluid regime, digitalis treatment may be begun by one or two intravenous injections. This has the advantage of acting quickly and with smaller doses. Once the improvement has begun treatment may be continued by mouth.
The contra-indications of intravenous digitalis therapy should constantly be borne in mind. These are:.
(1) In cases where there is danger of thrombosis and embolism.
(2) In the terminal stages of asystole. No good can possibly be derived in this condition.
(3) In cases where the nitrogen products are much increased in the blood stream (azotemia).
(4) In patients with mitral disease with slowing of the pulse and signs of auricular ventricular block.
(5) In cases of extreme insufficiently powers of these organs are so impaired that the added burden of digitalis intravenously will not prove helpful.
In general, a digitalis preparation designed for intravenous injection must meet the following requirements: It must be soluble in water, or at least in a weakly alcoholic menstrum. The tincture is of course not suitable. In addition injectible digitalis must be of uniform activity. It must exhibit a minimum of undesirable side actions; it must not deteriorate rapidly, and it must, not irritate the veins into which it has been injected.
Several specialized preparations of injectible digitalis are available. Digitan solution suitable for intravenous work comes in ampules each containing 1 cc. (16 minims) of a sterilized, isotonic, aqueous solution, equivalent to 12 grains of potent digitalis leaves. Nativelles crystallized digitaline in the from of 1:1000 solution is used by French physicians in from ten to thirty-five drops, diluted with 1 or 2 cc. of distilled, isotonic water. Digitalone is a highly purified aqueous solution of digitalis. One cubic centimeter contains 15 minims. Digitos is another standardized preparation of water-soluble active principles of digitalis. Colettas soluble digitoxin, or digalen, is another preparation of injectible digitalis. Another suitable digitalis preparation for intravenous work is digifoline.
Digitalis is, without doubt, the most useful remedy in the treatment of heart failure. It is almost a specific in some forms of cardiac disease. Now, even more than ever before, digitalis is the one physiopathologic drug in all cases of cardiac derangement in which failure is the predominant note. For the greatest measures of success digitalis must be given in appropriate cases and in proper doses. Otherwise, one cannot expect the full benefit of its use.
