Treatment with Digoxin – is it a clinical challenge? A Retrospective Analysis of Hospitalizations due to Digoxin intoxication
DOI:
https://doi.org/10.12775/JEHS.2024.65.008Keywords
digoxin poisoning, digoxin serum level, elderly patients, atrial fibrillation, congestive heart failure, chronic renal failureAbstract
Introduction and purpose: Digoxin, a cardiac glycoside derived from Digitalis lanata, has stood as a cornerstone in the treatment of various cardiovascular disorders for centuries. This study aims to delve into the demographic aspects, clinical characteristics, and outcomes associated with Digoxin poisoning. By drawing upon a dataset involving 22 patients hospitalized for Digoxin intoxication at the Clinical Department of Toxicology and Cardiology in Lublin, Poland, spanning from April 2014 to December 2023, our investigation seeks to provide an understanding of this issue.
Brief description of the state of knowledge: Despite the efficacy of Digoxin, the potential risk of intoxication, especially in the elderly, necessitate a comprehensive examination. Age-related changes, such as declining renal function, electrolyte imbalances, comorbidities and polypharmacy affect how drugs like Digoxin work. The symptoms of Digoxin poisoning can manifest in various organ systems such as cardiovascular, gastrointestinal, nervous system, highlighting the importance of prompt recognition to seek medical attention.
Methods and results: In our study, we analyzed data from 22 patients hospitalized due to Digoxin intoxication, focusing on demographic aspects, clinical characteristics and outcomes. The cases of Digoxin poisoning were categorized according to several factors, including the quantity and nature of substances consumed, the cause of intoxication, gender, age brackets, health conditions, peak serum Digoxin levels, length and outcomes of hospitalization.
Conclusions: Our study provides insights into the characteristics and outcomes of patients hospitalized due to Digoxin intoxication. The findings underscore the association of Digoxin poisoning, and emphasize the importance of monitoring serum levels to prevent adverse outcomes. As Digoxin continues to be relevant in treating cardiovascular conditions, our study calls for careful management and monitoring.
References
A. Hollman, “Digoxin comes from Digitalis lanata,” BMJ, vol. 312, no. 7035, p. 912, Apr. 1996, doi: 10.1136/BMJ.312.7035.912.
N. MacLeod-Glover PharmD Matthew Mink CSPI CGP Mark Yarema FRCPC Ryan Chuang, “Digoxin toxicity Case for retiring its use in elderly patients?”
J. Patocka, E. Nepovimova, W. Wu, and K. Kuca, “Digoxin: Pharmacology and toxicology-A review,” Environ. Toxicol. Pharmacol., vol. 79, Oct. 2020, doi: 10.1016/J.ETAP.2020.103400.
T. F. Whayne, “Clinical Use of Digitalis: A State of the Art Review,” Am. J. Cardiovasc. Drugs, vol. 18, no. 6, pp. 427–440, Dec. 2018, doi: 10.1007/S40256-018-0292-1/METRICS.
P. V. Marck and S. V. Pierre, “Na/K-ATPase Signaling and Cardiac Pre/Postconditioning with Cardiotonic Steroids,” Int. J. Mol. Sci. 2018, Vol. 19, Page 2336, vol. 19, no. 8, p. 2336, Aug. 2018, doi: 10.3390/IJMS19082336.
Di. M. Konstantinou, H. Karvounis, and G. Giannakoulas, “Digoxin in Heart Failure with a Reduced Ejection Fraction: A Risk Factor or a Risk Marker?,” Cardiology, vol. 134, no. 3, pp. 311–319, Jun. 2016, doi: 10.1159/000444078.
C. GM, W. JM, and K. H, “Pharmacokinetic considerations for digoxin in older people,” Open Cardiovasc. Med. J., vol. 5, no. 1, pp. 130–135, Jun. 2011, doi: 10.2174/1874192401105010130.
“Digoxin: Uses, Interactions, Mechanism of Action | DrugBank Online.” https://go.drugbank.com/drugs/DB00390 (accessed Jan. 20, 2024).
L. J. Yang et al., “Association of digoxin with mortality in patients with advanced chronic kidney disease: A population-based cohort study,” PLoS One, vol. 16, no. 1, Jan. 2021, doi: 10.1371/JOURNAL.PONE.0245620.
F. T. Muanda et al., “Digoxin Dosing and the Risk of Toxicity in Older Adults With CKD,” Am. J. Kidney Dis., vol. 79, no. 6, pp. 912–917, Jun. 2022, doi: 10.1053/j.ajkd.2021.09.024.
J. Puiguriguer Ferrando, S. Miralles Corrales, G. Frontera Juan, C. Campillo-Artero, and B. Barceló Martín, “Poisoning among the elderly,” Rev. Clínica Española (English Ed., vol. 221, no. 8, pp. 441–447, Oct. 2021, doi: 10.1016/J.RCENG.2020.08.004.
H. Arbabian, H. M. Lee, and A. Graudins, “Elderly patients with suspected chronic digoxin toxicity: A comparison of clinical characteristics of patients receiving and not receiving digoxin-Fab,” Emerg. Med. Australas., vol. 30, no. 2, pp. 242–248, Apr. 2018, doi: 10.1111/1742-6723.12873.
R. Baranowski et al., “Zalecenia dotyczące stosowania rozpoznań elektrokardiograficznych,” Polish Hear. J. (Kardiologia Pol., vol. 68, no. IV, pp. 335–390, 2010, doi: 10.33963/V.KP.79588.
“Podręcznik Interna - Medycyna Praktyczna: Digoksyna.” https://www.mp.pl/interna/chapter/B16.II.20.6. (accessed Jan. 19, 2024).
S. Pita-Fernández, M. Lombardía-Cortiña, D. Orozco-Veltran, and V. Gil-Guillén, “Clinical manifestations of elderly patients with digitalis intoxication in the emergency department,” Arch. Gerontol. Geriatr., vol. 53, no. 2, pp. e106–e110, Sep. 2011, doi: 10.1016/J.ARCHGER.2010.07.003.
L. Shi, L. D. Sun, and J. G. Odel, “Colored floaters as a manifestation of digoxin toxicity,” Am. J. Ophthalmol. Case Reports, vol. 10, pp. 233–235, Jun. 2018, doi: 10.1016/J.AJOC.2018.02.024.
“Wytyczne ESC 2021 dotyczące diagnostyki i leczenia ostrej i przewlekłej niewydolności serca.” https://ptkardio.pl/wytyczne/44-wytyczne_esc_2021_dotyczace_diagnostyki_i_leczenia_ostrej_i_przewleklej_niewydolnosci_serca (accessed Jan. 17, 2024).
R. D. Lopes et al., “Digoxin and Mortality in Patients With Atrial Fibrillation,” J. Am. Coll. Cardiol., vol. 71, no. 10, pp. 1063–1074, Mar. 2018, doi: 10.1016/J.JACC.2017.12.060.
Z. D. Goldberger and A. L. Goldberger, “Therapeutic ranges of serum digoxin concentrations in patients with heart failure,” Am. J. Cardiol., vol. 109, no. 12, pp. 1818–1821, Jun. 2012, doi: 10.1016/j.amjcard.2012.02.028.
F. Lapostolle et al., “Digoxin-specific Fab fragments as single first-line therapy in digitalis poisoning,” Crit. Care Med., vol. 36, no. 11, pp. 3014–3018, 2008, doi: 10.1097/CCM.0B013E31818B341C.
L. M. Bracken, B. S. H. Chan, and N. A. Buckley, “Physiologically based pharmacokinetic modelling of acute digoxin toxicity and the effect of digoxin-specific antibody fragments,” Clin. Toxicol. (Phila)., vol. 57, no. 2, pp. 117–124, Feb. 2019, doi: 10.1080/15563650.2018.1503288.
B. S. Chan et al., “Clinical outcomes from early use of digoxin-specific antibodies versus observation in chronic digoxin poisoning (ATOM-4),” Clin. Toxicol. (Phila)., vol. 57, no. 7, pp. 638–643, Jul. 2019, doi: 10.1080/15563650.2018.1546010.
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