Evaluation of patients presented to Dokuz Eylul University Hospital Emergency Department with elevated digoxin levels retrospectively

OBJECTIVES To investigate the demographic and clinical characteristics, laboratory measurements and treatments of patients who presented to University of Dokuz Eylul, School of Medicine, Department of Emergency Medicine and whose serum digoxin levels were 1.2 ng/mL or above.METHODS The demographic and clinical characteristics of patients with serum digoxin levels 1.2 ng/mL or above in the emergency department between January 2010 and July 2011 were investigated in this cross-sectional descriptive study. Data were first recorded to standart data forms prepared for the study and then to a data base program. Signs and symptoms of cases were evaluated in terms of digoxin intoxication. Chi-square and t-tests were used for the statistical analysis.RESULTS One hundred and thirty seven patients were included in the study. 68.6% of patients (n=94) were women with mean age 76.1±12.2. There was no statistical difference between gender and digoxin intoxication. The mean age of toxic patients was significantly higher than nontoxic patients (p=0.03). The most common comorbidities were congestive heart failure (n=91) and atrial fibrilation (n=74). Atrial fibrilation with slow ventricular response, sinus bradicardia and premature ventricular contractions were significantly higher in the toxic group (p<0.05). The most common signs and symptoms were nausea, vomiting and abdominal pain respectively. The hospitalizations and mortality of this group was significantly higher (p<0,001).DISCUSSION We found that digoxin intoxication was more common in advanced age, in females and in patients with congestive heart failure or atrial fibrillation between patients who presented to our emergency department between January 2010 and July 2011 and whose serum digoxin levels were 1.2 ng/mL or above. Digoxin intoxication must be suspected in patients presenting to the emergency department especially with complaints such as nausea and vomiting and if there are new electrocardiographic changes; and serum digoxin levels must be sent.KEY WORDS Digoxin, Intoxication, Emergency department