Digoxin intoxication: An old enemy in modern era

Abstract

ObjectivesAlthough development of new treatment modalities limited digoxin usage, digoxin intoxication is still an important issue which could be easily overlooked. In this report, we analyzed a case series definitively diagnosed as digoxin intoxication in the modern era.MethodsWe analyzed 71 patients hospitalized with digoxin intoxication confirmed by history, complaints, clinical and electrocardiograph (ECG) findings, and serum digoxin levels > 2.0 ng/mL, during a five year period. The demographic and clinical data, indications for digoxin use, digoxin dosage, concurrent medications, laboratory data, hospital monitoring, and ECG findings were obtained from all patients.ResultsThirty-eight of 71 patients (53.5%) had symptoms of heart failure during admission or later. Sixty-four percent of patients were older than 75 years. The percentage of females was 67%. Atrial fibrillation, hypertension and gastrointestinal complaints were more frequent in the females (64% in females, 30% in males, P = 0.007; 81% in female, 52% in males, P = 0.01; 50% in female, 17.3% in males, P = 0.008, respectively). The mortality rate during the hospital course was 7%.ConclusionsThis report demonstrated the reduced mortality rates in patients with digoxin intoxication over the study period. Gastrointestinal complaints are the most common symptoms in this population.

Investigation of factors affecting outcome of patients with acute digoxin intoxication in two academic emergency departments during 2004-2016

“…The rate of death was 7%; meanwhile, based on the results of the present study, it was noticed that the mortality rate was 4.9% lower than the study by Kirilmaz. The majority of deaths were in the recent study due to cardiac complications (5). Furthermore, Aarnoudse et al reported a lower mortality rate (0.7%) compared to that in this study (12).…”

“…Higher age and potassium levels above normal range were the factors that independently predicted poor prognosis in the patients. In a study carried out by Kirilmaz et al (2012), 71 patients with digoxin poisoning were investigated. In this study, 5-year time series has been selected for sampling.…”

“…(3) It was first used (1976) to treat patients with digoxin poisoned (4). Currently, indications of digoxin consumption are limited to advanced heart failure; however, acute and chronic toxicity with digoxin is still common (5,6).…”

“…The clinical manifestations of dioxin poisoning are wideranging, and cardiac findings are not specific to digoxin poisoning (9). The deaths from digoxin poisoning have been decreasing, with the rate of 20-30% in the early 1990s (10, 11) reaching to less than 10% in recent years (5,12). A review of published articles about digoxin poisoning shows that limited number of studies have been conducted in Iran (13,14), and further studies are needed, especially on the acute toxicity of digoxin.…”

Taking the Wrong Medication of Digoxin Tablets

“…As therapeutic and toxic dosages of cardiac glycosides are almost identical, drug toxicity is common (2). Digoxin toxicity effects different parts of the body, such as the central nervous system with many side effects, such as headache, fatigue, dizziness and visual disturbances, digestive system such as nausea, vomiting, anorexia, and the cardiovascular system, such as arrhythmia (3)(4)(5). These side effects could be more dangerous in the elderly as their recuperative abilities may be inadequate as a result of numerous factors, including impaired hepatic or renal function as well as chronic disease processes (6).…”