Republished: Symptomatic digoxin toxicity in a patient on haemodialysis

Digoxin has a narrow therapeutic index, such as complicated pharmacokinetics and dynamics. Many drug interactions may occur when the administration of one drug alters the clinical effects of another. As a result, digoxin toxicity can be a common condition within clinical settings that might lead to the development of many morbidities and even mortality. Many studies were published to investigate the efficacy and safety of different management modalities to enhance the outcomes that follow digoxin administration. The aim of the study was to discuss the approaches to systematically treat and prevent the development of cardiac digoxin toxicity. The findings are based on evidence from previous studies in the literature. To be specific, Fab fragments are the most effective modalities that can be used to treat severe cases within ideal periods. However, evidence regarding their administration for asymptomatic or mild cases is still poor regarding the cost-efficacy and the development of serious adverse events. Physicians should primarily care for a better intervention as it is usually associated with a significantly more enhanced prognosis and clinical outcomes. Nevertheless, adequate monitoring of the patients and evaluation of their personal and medical history are important steps in the process, and further approaches are still needed. Also, detailed information about our intended outcomes is furtherly discussed within the manuscript.

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Ten Years of Experience in Treating Patients With Digoxin Toxicity Without Using Digoxin Fab Antibody

International Journal of Medical Toxicology and Forensic Medicine ◽

10.32598/ijmtfm.v11i1.31239 ◽

2021 ◽

Vol 11 (1) ◽

pp. 31239.1-31239.10

Author(s):

Farzad Gheshlaghi ◽

◽

Anselm Wong ◽

Gholamali Dorooshi ◽

Rokhsareh Meamar ◽

...

Keyword(s):

Chronic Toxicity ◽

Digoxin Toxicity ◽

Years Of Experience ◽

Medical Sciences ◽

Ongoing Controversy ◽

Cardiac Symptoms ◽

Medical Documents ◽

Cardiac Manifestation ◽

N 93 ◽

Cardiac Manifestations

Background: Digoxin is extensively prescribed for cardiac diseases, so its chronic or acute toxicity commonly occur. Although digoxin specific antibodies (anti-digoxin Fab) are recommended to be used in patients with cardiac symptoms of digoxin toxicity, there is ongoing controversy about the effectiveness and dose of anti-digoxin Fab. Because our department lacks access to anti-digoxin Fab and the high cost of the antidote, we evaluated 10 years of experience in treating patients with digoxin toxicity without using digoxin Fab antibodies considering outcomes. Methods: A retrospective study was performed in Khorshid Hospital, affiliated with Isfahan University of Medical Sciences, from October 2008 to September 2018. Patients with acute or chronic digoxin toxicity were included in the study. The patients’ data were gathered and analyzed according to their medical documents. Results: Out of 150 cases with digoxin toxicity, 38% (n=57) were acute and 62% (n=93) were chronic. About 64.7% (n=97) were female. The most common non-cardiac manifestations of toxicity were gastrointestinal (67.3%, n=101) and neurological symptoms (52.7%, n=79). Bradyarrhythmia (80.5%, n=33) was the most cardiac manifestation in patients with acute (15.8% n=9) and chronic (25.8%, n=24) toxicity. A total of 144 (96%) cases fully recovered with supportive care, and 6 patients (4%) died. None of the cases received anti-digoxin Fab. Conclusion: The majority of presentations with acute or chronic toxicity recovered with supportive measures without using anti-digoxin Fab.

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Prognostic Utility of Serum Potassium in Chronic Digoxin Toxicity

American Journal of Cardiovascular Drugs ◽

10.2165/11590340-000000000-00000 ◽

2011 ◽

Vol 11 (3) ◽

pp. 173-178 ◽

Cited By ~ 18

Author(s):

Alex F. Manini ◽

Lewis S. Nelson ◽

Robert S. Hoffman

Keyword(s):

Serum Potassium ◽

Digoxin Toxicity ◽

Prognostic Utility

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Elderly patients with suspected chronic digoxin toxicity: A comparison of clinical characteristics of patients receiving and not receiving digoxin-Fab

Emergency Medicine Australasia ◽

10.1111/1742-6723.12873 ◽

2018 ◽

Vol 30 (2) ◽

pp. 242-248 ◽

Cited By ~ 5

Author(s):

Hooman Arbabian ◽

Hwee Min Lee ◽

Andis Graudins

Keyword(s):

Elderly Patients ◽

Clinical Characteristics ◽

Digoxin Toxicity

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Digoxin toxicity and cardiac pacing

OSCEs for the Final FFICM ◽

10.1017/cbo9781316443378.053 ◽

2016 ◽

pp. 141-143

Author(s):

Raj Nichani ◽

Brendan McGrath

Keyword(s):

Cardiac Pacing ◽

Digoxin Toxicity

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Digoxin and Low-Birth-Weight Infants

PEDIATRICS ◽

10.1542/peds.70.6.1011a ◽

1982 ◽

Vol 70 (6) ◽

pp. 1011-1012

Author(s):

DAVID S. OLANDER ◽

MICHAEL MAURER

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Premature Infants ◽

Elevated Serum ◽

Alternative Therapies ◽

Digoxin Toxicity ◽

Low Birth Weight Infants ◽

Serum Digoxin ◽

Clinically Significant

In their recent communication, Johnson et al suggested that conventional digoxin use may be sufficiently toxic forlow-birth-weight infants to prompt consideration of alternative therapies. This conclusion was supported by their detection of digitalis associated illness in 9/18 small premature infants receiving digoxin in doses of 0.003 to 0.005 mg/kg twice per day. The documentation of abnormally elevated serum digoxin concentrations in 7/9 patients further supports the possibility of clinically significant digoxin toxicity. Akin to the findings of Berman et al and Pinsky et al, this investigation only confirms the observation that overdosage of infants with digoxin may result in digitoxicity.

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