title: Clinical manifestations of elderly patients with digitalis intoxication in the emergency department.
abstract: This study aimed to determine the clinical characteristics of elderly patients diagnosed with digitalis intoxication, on the Emergency Department, University Hospital Complex, A Coruña, Spain. During the study period (January-September 2008) cases were included in which digitalis intoxication was confirmed by plasma digoxin levels. We collected data on age, gender, base-line diseases, therapeutic indications for digoxin, functional classification, ejection fraction, plasma digoxin levels, creatinine clearance, ions, gasometry, electrocardiogram, concomitant medication, symptomatology and treatment. The results were: mean age 82.0 ± 6.6 years, predominantly female subjects (83.7%). The most prevalent pathologies were cardiac valvulopathy (81.0%), hypertension (68.3%) and ischemic cardiopathy (46.3%), 95.1% had a background of cardiac insufficiency, and 52.6% were in functional grade III. The mean digoxin level was 2.7 ± 0.69 ng/ml, 23.1% of the patients had a creatinine clearance of less than 60 ml/min/1.73 m(2) and 2.6% had a severely reduced glomerular filtration rate (GFR) (clearance<30 ml/min/1.73 m(2)). A negative correlation was found between digoxin levels and clearance (r = -0.22; p = 0.18) and between the levels and cardiac frequency (r = -0.35; p = 0.026). Of the patients, 47.5% presented bradycardia and 87.8% arrhythmias, most frequently auricular fibrillation. The most frequent symptoms were nausea (54.8%), fatigue (42.9%), vomiting (33.3%) and anorexia (28.6%). We conclude that clinical digestive symptoms in elderly women who are taking digitalis, with bradycardia and impaired renal functioning, should lead us to suspect digitalis intoxication.
authors: Clinical Epidemiology and Biostatistics Unit, University Hospital Complex, A Coruña, As Xubias de Arriba 84, 15006 A Coruña, Spain. salvador.pita.fernandez@sergas.es
authors: Salvador
authors: S
authors: Pita-Fernández
authors: Mónica
authors: M
authors: Lombardía-Cortiña
authors: Domingo
authors: D
authors: Orozco-Veltran
authors: Vicente
authors: V
authors: Gil-Guillén
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000506:poisoning / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000188:drug therapy*; D001919:Bradycardia / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D004070:Digitalis; D004071:Digitalis Glycosides / Q000506:poisoning* / Q000627:therapeutic use; D004077:Digoxin; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D000889:Anti-Arrhythmia Agents; D004071:Digitalis Glycosides; D004077:Digoxin