A far-fetched medical procedure? On 'General Hospital'? Shock!

[okarol]

latimes.com THE UNREAL WORLD

A far-fetched medical procedure? On 'General Hospital'? Shock!
Heart attack from a digitalis-laced martini and a kidney-transplant story line are largely fiction.

Marc Siegel
The Unreal World

September 21, 2009

The premise

Having been poisoned with a martini laced with what turns out to be digitalis, Edward Quartermaine (John Ingle), chief executive of ELQ, has a heart attack while driving, plowing into a carnival and killing several people (including Andrea, the woman who poisoned him). Mobster Dominic Pirellie (Dominic Zamprogna) is hit by Edward's car while trying to push other people out of the way and is severely injured. After losing a lot of blood, he has kidney failure and is told he may require an urgent kidney transplant. It is then revealed that Dominic is really Dante Falconeri, the son of Olivia Falconeri (Lisa LoCicero). Olivia thinks of approaching Dante's father, crime lord Sonny Corinthos (Maurice Benard), as a possible kidney donor.

The medical questions

How effective is digitalis as a poison -- and can it precipitate a heart attack, leading to a car accident? Can the victim survive? Can someone who sustains a traumatic injury leading to substantial blood loss go into kidney failure as a result? Would a transplant be required to save him? Would the parents be considered as the first donors if compatible?

The reality

Digitalis, a drug that slows heart rate and strengthens heart contractions, can be poisonous at high doses, says Dr. Sandeep Jauhar, director of the heart failure program at Long Island Jewish Medical Center in New York. Digitalis toxicity usually results in nausea, abdominal pain, visual disturbances and heart arrhythmia and could certainly lead to a car accident. "It usually doesn't cause a heart attack," Jauhar says, "though it can cause ventricular tachycardia [a lethal heart rhythm] leading to a cardiac arrest." The victim likely would survive, Jauhar adds, if brought to the hospital and treated with an agent that binds the digitalis molecule, rendering it inactive.

The victim of a traumatic accident could sustain substantial blood loss and, because of a lack of blood flow, develop acute kidney failure. But it is "absolute nonsense" to contend that he would be a candidate for an emergency kidney transplant, says Dr. Gabriel Danovitch, medical director of the kidney transplant program at UCLA.

Adds Dr. Connie Davis, co-director of the kidney and pancreas transplant program at the University of Washington: "You would not do an emergency transplant because there is a chance that his kidneys would regain function. . . . We would usually wait for about three months to see if the kidney function would return."

For that reason, emergency transplants are generally not done. Instead, the patient would undergo dialysis while doctors waited to see whether the kidneys started working again.

If the kidney failure is irreversible, a transplant would ultimately be a better long-term option, "in terms of life expectancy, quality of life, and cost," says Dr. Lloyd Ratner, director of renal and pancreatic transplantation at Columbia University, College of Physicians and Surgeons.

Finally, parents may be strong donor candidates, but a perfectly matched sibling would be preferable.

Siegel is an associate professor of medicine at New York University's School of Medicine.

marc@doctorsiegel.com

Copyright © 2009, The Los Angeles Times
latimes.com/features/health/la-he-unreal21-2009sep21,0,6154711.column

[Rerun]

Sounds like the writers need to do their homework.