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Assessment of digoxin antibody use in patients with elevated serum digoxin following chronic or acute exposure

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Abstract

Objective

To evaluate the use of antidotal therapy in patients with an elevated digitalis concentration following chronic or acute exposure.

Design and setting

Retrospective review of patient records over 2 years in 20 city hospitals in France.

Patients

Overall 838 patients with an elevated serum digitalis concentration (digoxin > 1.95 ng/ml or digitoxin > 23 ng/ml) were included in the study. Of these, 67 (8%) had received antidotal therapy with Fab fragments.

Measurements and results

The relationships between previously reported prognostic criteria and use of antidotal therapy were investigated. We identified five independent factors that were associated with the use of antidotal therapy: acute overdose (OR 15.74), Fab fragment availability in the hospital (11.06), serum potassium (1.81), and heart rate (0.96). Mortality was significantly lower in Fab-treated (6%, 4/67) than untreated patients (15%, 117/770).

Conclusions

Antidotal therapy is underused in patients with an elevated digitalis concentration especially in patients with chronic digitalis exposure. These patients in our series presented a higher mortality rate than patients with acute poisoning. Although they were older and tended to have a history of cardiac disease, they did not differ from patients with acute poisoning with regard to the main severity criteria and prognostic factors. The use of identical criteria for antidotal treatment after acute and chronic poisoning should help optimize outcomes. Fab fragment availability is insufficient in France but ranks only second after type of poisoning (acute or chronic) in the multivariate association with Fab treatment.

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Authors and Affiliations

  1. SAMU 93, EA 3409, Hôpital Avicenne, 125 rue de Stalingrad, Bobigny, France

    Frédéric Lapostolle, Carine Verdier & Frédéric Adnet

  2. Toxicological and Intensive Care Unit, Hôpital Lariboisière, Paris, France

    Frédéric Lapostolle, Bruno Mégarbane & Frédéric Baud

  3. Emergency Medicine, Department of Surgery, and South Texas Poison Center, University of Texas Health Science Center, TX 78229, San Antonio, USA

    Stephen W. Borron

  4. SAMU 44, Centre Hospitalier Universitaire de Nantes, Nantes, France

    Fabrice Arnaud

  5. SAMU 29, Hôpital La Cavale, Centre Hospitalier Universitaire de Brest, Brest, France

    James Couvreur

Authors
  1. Frédéric Lapostolle
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  2. Stephen W. Borron
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  3. Carine Verdier
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  4. Fabrice Arnaud
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  5. James Couvreur
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  6. Bruno Mégarbane
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  7. Frédéric Baud
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  8. Frédéric Adnet
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Corresponding author

Correspondence to Frédéric Lapostolle.

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Lapostolle, F., Borron, S.W., Verdier, C. et al. Assessment of digoxin antibody use in patients with elevated serum digoxin following chronic or acute exposure. Intensive Care Med 34, 1448–1453 (2008). https://doi.org/10.1007/s00134-008-1092-x

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  • DOI: https://doi.org/10.1007/s00134-008-1092-x

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