Resumen :
La intoxicación digitálica es un motivo recurrente de consulta en los servicios de urgencias hospitalarios (SUH), que acontece en pacientes con tratamiento crónico y en intoxicaciones agudas, mucho menos frecuentes, asociadas a tentativas autolíticas en algunos casos.
Objetivo. Identificar las cara... Ver más
Digitalis intoxication is a recurrent reason for consultation in hospital emergency services (HES), occurring in patients with chronic treatment and in much less frequent acute intoxications, associated with autolytic attempts in some cases.
Objective. To identify the clinical and laboratory characteristics of patients with digoxin poisoning in an HES; analyze the degree of compliance and administration of their specific antidote, antidigoxin antibodies (ADAbs) in life-threatening situations, as well as assess effects on morbidity and mortality, identifying risk factors for short-term revisit, readmission, or mortality, 30 days after their evaluation in the emergency department.
Method. Retrospective cohort study, including cases diagnosed and discharged from emergency to hospitalization or home, with digoxin poisoning between 2004 and 2023 in patients over 14 years old. Demographic, clinical, and electrocardiographic variables were collected, including the use of antidigoxin antibodies (ADAbs), with the main outcome variable being clinical evolution, overall mortality related or unrelated, and mortality at 30 days, extrahospital or intrahospital mortality, emergency department revisit or readmission (related or unrelated), within 30 days after emergency department evaluation.
Results.
A total of 175 patients were included, of whom 35 (20%) were male and 140 (80%) were female, with a median age of 84 years (IQR: 77.32-87.17). The reason for intoxication was considered accidental in 173 patients (98.9%) and suicidal in only 2 (1.1%). After analyzing the symptoms, it was observed that 76 (43.4%) of them presented digestive disorders, 51 (29.1%) had neurological symptoms, and only 30 (17.1%) presented cardiac symptoms. Arrhythmias were observed in 109 (62.3%) patients, with 105 (96.3%) cases being classified as slow and only 4 (3.7%) as fast. Fourteen (8%) of them had an indication for antidigoxin antibody administration, and finally, it was administered in only one patient (7.1%). Notably, 101 (57.7%) of the patients studied had creatinine levels above 1.2 mg/dL. Regarding potassium levels, 30 (17.1%) patients had levels above 5.5 mEq/L, while 18 (10.3%) patients had potassium levels below 3.5 mEq/L. In total, 62 (35.4%) cases experienced a combined event, death and/or readmission within less than 30 days.
Conclusions.
The studied sample mainly comprised elderly patients. Most cases were considered accidental intoxications, highlighting the need to improve education and safety in digoxin management, especially in this vulnerable population. Digestive and neurological disorders were common, emphasizing the importance of thorough clinical evaluation. Hyperkalemia was evidenced as a severity marker and hypokalemia as a predisposing factor for intoxications in patients with chronic treatment. The high prevalence of arrhythmias, mainly slow, suggests significant effects on the cardiovascular system, requiring careful monitoring and management. Despite indications in some cases, the low rate of antidigoxin antibody administration suggests the need to review and improve treatment protocols, as well as their availability. The high proportion of patients with abnormal levels of creatinine and potassium suggests a significant association with renal dysfunction, influencing prognosis and clinical management. The high rate of mortality and readmissions in a short period highlights the severity of intoxication and the need for continuous medical attention.
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