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Elderly patients with suspected chronic digoxin toxicity: A comparison of clinical characteristics of patients receiving and not receiving digoxin‐Fab
Author(s) -
Arbabian Hooman,
Lee Hwee Min,
Graudins Andis
Publication year - 2018
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12873
Subject(s) - digoxin , medicine , creatinine , renal function , heart failure , heart rate , gastroenterology , anesthesia , blood pressure
Objective The aim of the present study was to compare clinical features of patients with elevated serum digoxin concentrations who were treated with digoxin‐Fab with those where the immunotherapy was not given by a tertiary hospital toxicology service. Methods This was a retrospective series of patients with supratherapeutic serum digoxin concentrations referred to the toxicology service from August 2013 to October 2015. Data collected included demographics, presenting complaint, digoxin dose, other medications taken, serum digoxin, potassium and creatinine concentration on presentation and initial and post‐digoxin‐Fab heart rate. Results There were 47 referrals. Digoxin‐Fab was administered in 21 cases. It was given more commonly when the heart rate was <51/min or serum potassium was >5.0 mmol/L. Patients receiving digoxin‐Fab were more likely to be on maintenance therapy with beta‐blockers or calcium channel blockers (95% vs 61%; OR 13.1; 95% CI 1.5–113) and/or potassium‐sparing medications (95% vs 54%; OR 17.1; 95% CI 2.0–147). They had elevated serum creatinine (76% vs 42%; OR 8.2; 95% CI 1.9–34), higher serum potassium (median: 5.1 mmol/L vs 4.2 mmol/L, P = 0.02), higher serum digoxin concentration (median: 3.5 nmol/L vs 2.3 nmol/L, P = 0.02) and pretreatment heart rate <51/min (66% vs 31%; OR 4.5; 95% CI 1.3–15). There were no patients with ventricular arrhythmias or hypotension. Median heart rate increased by 10/min 1 and 4 h after digoxin‐Fab. However, individual heart rate response to digoxin‐Fab was variable. Conclusion Digoxin‐Fab was more commonly administered when heart rate was <51/min. It had a small effect on increasing heart rate; however, individual response to digoxin‐Fab was variable as patients were using other negative chronotropic medications. In symptomatic bradycardic patients on multiple heart failure medications, positive chronotropic and potassium‐lowering therapies should be considered in concert with digoxin‐Fab.