Development and validation of a risk prediction nomogram for serious arrhythmias in acute digoxin toxicity among pediatrics: A multicenter study

El Gameel, Dina; Sharif, Asmaa Fady; Shoeib, Osama; Elgebally, Elsayed Ibrahim; Fayed, Manar Maher

doi:10.1016/j.toxicon.2023.107241

Cited by 3 publications

(1 citation statement)

References 47 publications

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“…High-dose digoxin intoxication has been found to frequently result in arrhythmias, particularly ventricular conduction block, but arrhythmias associated with heightened autonomic activity are rather uncommon. [14,15] The utilization of temporary cardiac pacemaker implantation has demonstrated efficacy in the management of diverse arrhythmias resulting from digoxin toxicity. Therefore, the patient here who experienced the onset of type II atrioventricular block over the course of treatment was treated with temporary pacemaker implantation for remedial purposes.…”

Section: Discussionmentioning

confidence: 99%

A case of digoxin intoxication caused by short-term massive overdose: Case report

Li,

Zhang,

Liu

2024

Medicine

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Rationale: Digoxin is a frequently prescribed medication for the management of both acute and chronic cardiac insufficiency. The overdose ingestion of digoxin can result in a range of arrhythmias, with severe cases potentially leading to malignant arrhythmias and fatal outcomes. To date, there is a lack of documented cases related to acute digoxin intoxication resulting from the administration of massive digoxin overdose in the short term. Patient concerns: A 37-year-old female patient was admitted to the emergency department following a suicide attempt involving the administration of 330 tablets of digoxin (each tablet containing 0.25 mg). The patient exhibited symptoms of confusion, nausea, and vomiting for around 30 minutes. The patient had a history of depression. Diagnoses: The patient was diagnosed with digoxin intoxication. Interventions: The patient underwent many medical interventions including stomach lavage, administration of laxatives, correction of cardiac arrhythmias, provision of myocardial nutrition, diuresis, correction of acid-base balance, and management of electrolyte disturbances, among others. Outcomes: Following a treatment of 9 days, the patient exhibited no signs of discomfort, maintained consciousness, and the serum concentration of digoxin was indeterminable. Upon reevaluation of the electrocardiogram, it was determined that no arrhythmia was present. Consequently, the patient was authorized to be discharged from the hospital. Conclusions: There is currently no documented evidence of cases involving a significant overdose of digoxin resulting in intoxication. The patient had a comprehensive treatment regimen consisting of stomach lavage, administration of a laxative, correction of cardiac arrhythmias, provision of myocardial nutrition, fluid replacement, diuresis, and supportive therapy, resulting in successful outcomes. Lessons: There have been no known cases of intoxication resulting from a significant overdose of digoxin, specifically with the consumption of 330 tablets (0.25 mg/tablet). However, in the event of ingesting excessive amounts of digoxin, it is imperative to promptly administer stomach lavage, administration of a laxative, and arrhythmia correction. The administration of temporary pacemaker therapy is recommended for patients presenting with high atrioventricular block, whereas hemoperfusion is advised for patients with renal insufficiency as a means to eliminate digoxin from the body.

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Section: Discussionmentioning

confidence: 99%

A case of digoxin intoxication caused by short-term massive overdose: Case report

Li,

Zhang,

Liu

2024

Medicine

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Development of a risk-prediction nomogram for in-hospital adverse cardiovascular events in acute cardiotoxic agents poisoning

Lashin,

Elgazzar,

El sharkawy

et al. 2024

Toxicology Reports

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Development and validation of a nomogram for predicting mechanical ventilation need among acutely intoxicated patients with impaired consciousness

Lashin,

Sobeeh,

Sobh

2024

Hum Exp Toxicol

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Background A considerable portion of acutely intoxicated patients is presented with impaired consciousness. Early identification of those patients who require advanced medical care, such as mechanical ventilation (MV), can improve their prognosis. Methods This study included 330 acutely intoxicated patients who were presented with impaired consciousness and admitted to Tanta University Poison Control Center, Egypt, in the period from January 2021 to December 2023. Patients were enrolled in derivation (257 patients) and validation (73 patients) cohorts. Patients’ data were analyzed to develop and validate a predictive nomogram to determine the probability of MV need in acutely intoxicated patients. Results Significant predictors for MV need were mean arterial blood pressure (OR = 0.96, p = .014), PaO2 (OR = 0.96, p = .001), pH (OR = 0.00, p < . 001), and glucose/potassium ratio (OR = 1.59, p = .030). These four parameters were used to formulate a bedside nomogram. Receiver-operating characteristic (ROC) analysis for the proposed nomogram shows that area under the curve (AUC) = 95.7%, accuracy = 93.4%, sensitivity = 88.9%, and specificity = 95.1%. The internal validation for the developed nomogram was assessed using a bootstrapping method and calibration curve. Regarding external validation, AUCs for the developed nomogram probability was 96.5%, and for predicted probability using the developed nomogram was 97.8%. Conclusion The current study provides a validated nomogram that could be used as a reliable tool for the accurate prediction of MV need among acutely intoxicated patients with impaired consciousness. It could assist in the early identification of patients who will require MV, especially in low-income countries with limited resources.

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Development and validation of a risk prediction nomogram for serious arrhythmias in acute digoxin toxicity among pediatrics: A multicenter study

Cited by 3 publications

References 47 publications

A case of digoxin intoxication caused by short-term massive overdose: Case report

A case of digoxin intoxication caused by short-term massive overdose: Case report

Development of a risk-prediction nomogram for in-hospital adverse cardiovascular events in acute cardiotoxic agents poisoning

Development and validation of a nomogram for predicting mechanical ventilation need among acutely intoxicated patients with impaired consciousness

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