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Predictive Factors for Recurrence of Serious Arrhythmias in Patients with Acute Digoxin Poisoning

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Abstract

Although digoxin poisoning has declined in the past decades, it still has deleterious outcomes. The hallmark of serious life-threatening arrhythmias remains challenging due to its non-specific initial presentation. Therefore, this study aimed to evaluate the initial predictive factors for recurrent serious arrhythmias and the need for temporary pacing in acute digoxin-poisoned patients. This retrospective cohort study included all patients with acute digoxin poisoning admitted to Tanta University Poison Control Center from 2017 to 2020. Demographic and toxicological data, poisoning severity score (PSS), laboratory investigations, and serial ECG monitoring data were documented. Patients were divided according to their age into a childhood group and adolescence & adulthood group. Each age group was divided into two subgroups according to the presence of recurrent serious arrhythmias. Patient outcomes, including intensive care unit admission, temporary pacing, and in-hospital mortality were recorded. A percentage of 37.34% (n = 31) of the included patients had recurrent serious arrhythmias in both groups. Recurrent serious arrhythmias groups had significantly low heart rate, prolonged PR interval, high PSS, Mobitz II dysrhythmias, elevated serum digoxin, serum potassium and serum creatinine, and increased adverse outcomes compared to other groups. Logistic regression analysis showed that only serum digoxin and potassium levels were significant independent predictors of recurrent serious arrhythmias and temporary pacing. Serum digoxin level had an excellent discriminatory power with the best sensitivity and specificity, followed by serum potassium level in both groups. Thus, monitoring serum digoxin and potassium levels is essential in all patients with acute digoxin poisoning, especially with limited Fab availability.

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Data Availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

All authors express their gratitude to Tanta University Poison Control Center staff members for their support and help in this study.

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The authors did not receive any support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, 6th floor, Medical Collages Complex, El-Gaish Street, Tanta, 31527, Gharbia, Egypt

    Ghada N. El-Sarnagawy & Nadia E. Helal

  2. Department of Cardiology, Faculty of Medicine, Tanta University, Tanta, Egypt

    Sara I. El sharkawy

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  1. Ghada N. El-Sarnagawy
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Contributions

Dr. GNE contributed to the study’s conception and design. Dr. NEH performed material preparation and data collection. Dr. GNE, Dr. NEH, and Dr. SIE performed data interpretation and analysis. The manuscript’s first draft was written by Dr. GNE and Dr. NEH. All authors commented on the manuscript’s previous versions. Also, they read and approved the final version.

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Correspondence to Ghada N. El-Sarnagawy.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical Approval

This retrospective study involving human participants was according to the ethical standards of the institutional and national research committee as well as the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The research ethics committee of the Faculty of Medicine of Tanta University approved this study (Approval number: 33932/7/20).

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Written informed consent was waived as this study is retrospective.

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Handling Editor: Vittorio Fineschi.

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El-Sarnagawy, G.N., El sharkawy, S.I. & Helal, N.E. Predictive Factors for Recurrence of Serious Arrhythmias in Patients with Acute Digoxin Poisoning. Cardiovasc Toxicol 21, 835–847 (2021). https://doi.org/10.1007/s12012-021-09673-y

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