Citation

Nogué S, Cino J, Civeira E, Puiguriguer J, Burillo-Putze G, Dueñas A, Soy D, Aguilar R, Corominas N. Emergencias 2012; 24(6): 462-475.

Copyright

(Copyright © 2012, SEMES - Sociedad Española de Medicina de Urgencias y Emergencias)

DOI

unavailable

PMID

unavailable

Abstract

Digitalis poisoning, particularly in persons under long-term digoxin therapy, is a reason for repeated visits to Spanish emergency departments. Acute poisoning is rare but may occur as a result of attempted suicide or the intake of plants that contain cardiac glycosides. Kidney failure modifies digoxin pharmacokinetics and is an important trigger for severe adverse reactions to the drug. Clinical manifestations are nonspecific but usually include gastrointestinal events (nausea, vomiting, diarrhea, and abdominal pain) along with circulatory effects (hemodynamic instability, dizziness or lightheadedness, and syncope). Bradycardia (slow atrial fibrillation, conduction blocks) is common and may cause asystole. Tachyarrhythmias may lead to ventricular fibrillation. In acute digitalis poisoning, hyperkalemia is a risk factor for cardiac arrest. The digoxin plasma concentration can indicate the severity of the poisoning, provided the tissue-toplasma ratio is at steady state. To treat acute poisoning, administer activated charcoal within the first few hours after digitalis intake. In such cases, or in poisoning during long-term digoxin therapy, continuous electrocardiographic monitoring is essential and potassium and magnesium concentrations should be brought within the normal range. The first-line treatment for bradycardia is atropine. Ventricular arrhythmias are treated with phenytoin or lidocaine. In lifethreatening situations, antidigoxin antibodies must be used. They should be available in all referral or high-level tertiary care facilities and are administered according to the total digoxin body load.

Language: en

Keywords

Poisoning; Digitalis; Antidigoxin antibodies; Emergency health services