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

• Published in: Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias Vol. 35; no. 5; p. 328
• Main Authors: Supervía, August, Martínez Baladrón, Andrea, Córdoba, Francisca, Callado, Francisco, Lobo Antuña, Victoria, Puiguriguer, Jordi, Fuentes, Elena, Molina Samper, Valle, Caballero-Bermejo, Antonio F, Vert, Susana, Ruíz-Ruíz, Francisco, Guijarro Eguinoa, F Javier, Martín-Pérez, Beatriz, Olmos, Samuel, Burillo-Putze, Guillermo, Maza Vera, María Teresa, Pallàs, Oriol, Climent, Benjamín, Igartua Astibia, Maider, Gutiérrez, Edith, Nogué, Santiago, Ferrer Dufol, Ana
• Format: Journal Article
• Language: English
• Published: Spain 01.10.2023
• Subjects: Aged; Aged, 80 and over; Antidotes; Chronic Disease; Digoxin; Emergency Service, Hospital; Female; Humans; Male; Retrospective Studies; Anticuerpos antidigoxina; Chronic toxicity; Digoxin; Digoxina; Digoxin antibodies; Poisoning; Intoxicaciones; Intoxicación crónica
• ISSN: 2386-5857

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. 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. 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%. 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.