Digitalis poisoning: the basis for treatment with antidigoxin antibodies

Nogué S, Cino J, Civeira E, Puiguriguer J, Burillo-Putze G, Dueñas A, Soy D, Aguilar R, Corominas N

Digitalis poisoning, particularly in persons under long-term digoxin therapy, is a reason

for repeated visits to Spanish emergency departments. Acute poisoning is rare but may

occur as a result of attempted suicide or the intake of plants that contain cardiac

glycosides. Kidney failure modifies digoxin pharmacokinetics and is an important trigger

for severe adverse reactions to the drug. Clinical manifestations are nonspecific but

usually include gastrointestinal events (nausea, vomiting, diarrhea, and abdominal pain)

along with circulatory effects (hemodynamic instability, dizziness or lightheadedness,

and syncope). Bradycardia (slow atrial fibrillation, conduction blocks) is common and

may cause asystole. Tachyarrhythmias may lead to ventricular fibrillation. In acute

digitalis poisoning, hyperkalemia is a risk factor for cardiac arrest. The digoxin plasma

concentration can indicate the severity of the poisoning, provided the tissue-to-plasma

ratio is at steady state. To treat acute poisoning, administer activated charcoal within the

first few hours after digitalis intake. In such cases, or in poisoning during long-term

digoxin therapy, continuous electrocardiographic monitoring is essential and potassium

and magnesium concentrations should be brought within the normal range. The firstline

treatment for bradycardia is atropine. Ventricular arrhythmias are treated with

phenytoin or lidocaine. In life-threatening situations, antidigoxin antibodies must be

used. They should be available in all referral or high-level tertiary care facilities and are

administered according to the total digoxin body load.

Aguilar R, Burillo-Putze G, Cino J, Civeira E, Corominas N, Dueñas A, Nogué S, Puiguriguer J, Soy D