Summary

Characteristics of digoxin toxicity attended in Spanish emergency departments according to type of poisoning and administration of digoxin antibodies: the DIGITOX study

August Supervía1-4, Andrea Martínez Baladrón5, Francisca Córdoba3,4,6, Francisco Callado7, Victoria Lobo Antuña8, Jordi Puiguriguer4,9, Elena Fuentes3,10, Valle Molina Samper11, Antonio F. Caballero-Bermejo12, Susana Vert3,13, Francisco Ruíz-Ruíz14, F. Javier Guijarro Eguinoa15, Beatriz Martín-Pérez16, Samuel Olmos3,17, Guillermo Burillo-Putze4,18, María Teresa Maza Vera5, Oriol Pallàs1,2, Benjamín Climent8, Maider Igartua Astibia11, Edith Gutiérrez12, Santiago Nogué3,4, Ana Ferrer Dufol4

Affiliation of the authors

1Servicio de Urgencias, Hospìtal del Mar, Barcelona, Spain. 2Unitat Funcional de Toxicología del Parc de Salut Mar, Barcelona, Spain. 3Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox), Spain. 4Fundación Española de Toxicología Clínica, Spain. 5Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, Spain. 6Servicio de Urgencias, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain. 7Servicio de Urgencias, Unidad de Toxicología Clínica, Hospital Universitario de Burgos, Burgos, Spain. 8Consorci Hospital General Universitari, Valencia, Spain. 9Servicio de Urgencias, Hospital Son Espases, Mallorca, Spain. 10Servicio de Urgencias, Hospital Universitari de Bellvitge, Barcelona, Spain. 11Servicio de Urgencias, Hospital Universitario de Navarra, Pamplona, Spain. 12Hospital Puerta de Hierro, Majadahonda, Madrid, Spain. 13Servicio de Urgencias, Hospital de Viladecans, Barcelona, Spain. 14Servicio de Urgencias, Hospital Clínico, Zaragoza, Spain. 15Servicio de Urgencias, Hospital La Paz, Madrid, Spain. 16Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Universitario Río Ortega, Valladolid, Spain. 17Servicio de Urgencias, Consorci Hospitalari Parc Taulí de Sabadell, Barcelona, Spain. 18Universidad Europea de Canarias, Facultad de Ciencias de la Salud, Tenerife, Spain.

DOI

Quote

Supervía A, Martínez Baladrón A, Córdoba F, Callado F, Lobo Antuña V, Puiguriguer J, et al. Characteristics of digoxin toxicity attended in Spanish emergency departments according to type of poisoning and administration of digoxin antibodies: the DIGITOX study. Emergencias. 2023;35:328-34

Summary

Background and objective.

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.

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%.

Conclusions.

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.

 

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