Characteristics of digoxin toxicity attended in Spanish emergency departments according to type of poisoning and administration of digoxin antibodies: the DIGITOX study
Year: 2024
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: Digoxin toxicity accounts for a small percentage of poisonings attended by emergency departments. This study aimed to describe differences between acute and chronic digoxin toxicity and assess the use of digoxin-specific antibody fragments (digoxin-Fab) as an antidote. MATERIAL AND METHODS: Retrospective, observational, multicenter study in 15 hospital emergency departments in 8 Spanish autonomous communities in 7 years. We collected patient, clinical and treatment variables, and discharge destination. Patients were classified according to whether toxicity was acute or chronic and whether digoxin-Fab was administered or not. RESULTS: Twenty-seven acute and 631 chronic digoxin poisonings were attended. The mean (SD) patient age was 83.9 (7.9) years, and 76.9% were women. Patients with acute toxicity were younger (80.0 [12] years) than those with chronic toxicity (84.1 [7.7] years) (P .038), and accidental poisoning was less common (in 85.2% vs 100% in chronic toxicity; P .001). Cases of acute toxicity were also more serious (Poison Severity Score (29.6% vs 12.5% in chronic toxicity; P .001). Thirty-four patients were treated with digoxin-Fab (5.4%). These patients were younger (78.7 [11.5] years vs 84.2 (7.6) years), their toxicity was more often acute (in 20.6% vs 3.2% in chronic toxicity), more had attempted suicide (8.8% vs 0.2% with chronic toxicity), and more had severe symptoms (50% vs 11.2%) (P .001, all comparisons). Hospital admission was required for 76.1%. Overall, mortality was 11.4%. CONCLUSION: Chronic toxicity accounts for most digoxin poisoning cases, and most patients are women. Acute toxicity is more serious. Patients who required digoxin-Fab have more severe poisoning. Such patients usually have acute toxicity, and attempted suicide is more often the reason for the emergency.
Source: Emergencias
Authors: August Supervía, Andrea Martínez Baladrón, Francisca Córdoba, Francisco Callado, Victoria Lobo Antuña, Jordi Puiguriguer, Elena Fuentes, Valle Molina Samper, Antonio F Caballero-Bermejo, Susana Vert, Francisco Ruíz-Ruíz, F. Javier Guijarro Eguinoa, Beatriz Martín-Pérez, Samuel Olmos, Guillermo Burillo-Putze, María Teresa Maza Vera, Oriol Pallàs, Benjamín Climent, Maider Igartua Astibia, Edith Gutiérrez, Santiago Nogué, Ana Ferrer Dufol
Institutions: Hospital Del Mar, Parc de Salut, Hospital de Sant Joan Despí Moisès Broggi, Hospital Universitario de Burgos, Hospital Universitario Son Espases, Bellvitge University Hospital, Hospital Universitario Puerta de Hierro Majadahonda, Hospital de Viladecans, Hospital Universitario La Paz, Corporació Sanitària Parc Taulí, Universidad Europea de Canarias
Language: Spanish
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4387420697