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Title: | Elderly patients with suspected chronic digoxin toxicity: A comparison of clinical characteristics of patients receiving and not receiving digoxin-Fab. | Authors: | Lee H.M. ;Arbabian H.;Graudins A. | Institution: | (Arbabian, Lee, Graudins) Monash Clinical Toxicology Unit, Emergency Medicine Service, Acute Medicine and Ambulatory Care Program, Monash Health, Melbourne, VIC, Australia (Arbabian, Lee, Graudins) Emergency Department, Dandenong Hospital, Monash Health, Melbourne, VIC, Australia (Lee, Graudins) Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia | Issue Date: | 5-Apr-2018 | Copyright year: | 2018 | Publisher: | Blackwell Publishing | Place of publication: | Australia | Publication information: | EMA - Emergency Medicine Australasia. 30 (2) (pp 242-248), 2018. Date of Publication: April 2018. | Journal: | EMA - Emergency Medicine Australasia | Abstract: | 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. Method(s): 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. Result(s): 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(s): 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.Copyright © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1111/1742-6723.12873 | ORCID: | Graudins, Andis; ORCID: http://orcid.org/0000-0002-0310-3983 | Link to associated publication: | Click here for full text options | PubMed URL: | 29316267 [http://www.ncbi.nlm.nih.gov/pubmed/?term=29316267] | ISSN: | 1742-6731 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/37510 | Type: | Article | Subjects: | retrospective study aged *aging article clinical article *clinical feature comparative study creatinine blood level demography *digitalis intoxication drug blood level female heart rate heart ventricle arrhythmia human hypotension immunotherapy maintenance therapy male potassium blood level priority journal tertiary care center toxicology beta adrenergic receptor blocking agent calcium channel blocking agent creatinine/ec [Endogenous Compound] *digoxin antibody F(ab) fragment/cr [Drug Concentration] potassium/ec [Endogenous Compound] potassium sparing diuretic agent maintenance therapy drug blood level hypotension *digitalis intoxication demography potassium blood level priority journal retrospective study tertiary care center toxicology male *aging human heart ventricle arrhythmia heart rate female immunotherapy creatinine blood level comparative study *clinical feature clinical article Article aged |
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