• August Supervía, Andrea Martínez Baladrón, Francisca Córdoba, Francisco Callado, Victoria Lobo Antuña, Jordi Puiguriguer, Elena Fuentes, Valle Molina Samper, Antonio F Caballero-Bermejo, Susana Vert, Francisco Ruíz-Ruíz, F Javier Guijarro Eguinoa, Beatriz Martín-Pérez, Samuel Olmos, Guillermo Burillo-Putze, María Teresa Maza Vera, Oriol Pallàs, Benjamín Climent, Maider Igartua Astibia, Edith Gutiérrez, Santiago Nogué, and Ana Ferrer Dufol.
• Servicio de Urgencias, Hospìtal del Mar, Barcelona, España. Unitat Funcional de Toxicología del Parc de Salut Mar, Barcelona, España. Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox), España. Fundación Española de Toxicología Clínica, España.
• Emergencias. 2023 Oct 1; 35 (5): 328334328-334.

ObjectivesDigoxin toxicity accounts for a small percentage of poisonings attended by emergency departments. This study aimed to describe differences between acute and chronic digoxin toxicity and assess the use of digoxin-specific antibody fragments (digoxin-Fab) as an antidote.Material And MethodsRetrospective, observational, multicenter study in 15 hospital emergency departments in 8 Spanish autonomous communities in 7 years. We collected patient, clinical and treatment variables, and discharge destination. Patients were classified according to whether toxicity was acute or chronic and whether digoxin-Fab was administered or not.ResultsTwenty-seven acute and 631 chronic digoxin poisonings were attended. The mean (SD) patient age was 83.9 (7.9) years, and 76.9% were women. Patients with acute toxicity were younger (80.0 [12] years) than those with chronic toxicity (84.1 [7.7] years) (P .038), and accidental poisoning was less common (in 85.2% vs 100% in chronic toxicity; P .001). Cases of acute toxicity were also more serious (Poison Severity Score (29.6% vs 12.5% in chronic toxicity; P .001). Thirty-four patients were treated with digoxin-Fab (5.4%). These patients were younger (78.7 [11.5] years vs 84.2 (7.6) years), their toxicity was more often acute (in 20.6% vs 3.2% in chronic toxicity), more had attempted suicide (8.8% vs 0.2% with chronic toxicity), and more had severe symptoms (50% vs 11.2%) (P .001, all comparisons). Hospital admission was required for 76.1%. Overall, mortality was 11.4%.ConclusionChronic toxicity accounts for most digoxin poisoning cases, and most patients are women. Acute toxicity is more serious. Patients who required digoxin-Fab have more severe poisoning. Such patients usually have acute toxicity, and attempted suicide is more often the reason for the emergency.

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