Investigation of factors affecting outcome of patients with acute digoxin intoxication in two academic emergency departments during 2004-2016

Acute digoxin intoxication is a relatively common cause of poisoning. It might be fatal especially in patients with cardiovascular underlying diseases or the cases ingesting a large dose of digoxin intentionally or accidentally. The aim of this study was to investigate the outcome of the patients admitted to the Emergency Department with digoxin intoxication. Moreover, the prognostic factors were studied. This observational cross-sectional study investigated the outcome of patients with acute digoxin intoxication during 2004 to 2016. All the patients were admitted to the emergency department, with acute or acute on chronic poisoning entered the study within 13 years. The documents of emergency departments, ordinary wards, and intensive care units (ICUs) were studied. The outcome and mortality of the patients was investigated. The collected data were analyzed using SPSS software (version 18). The significance level was considered less than 0.05. The chi-squared test and Fisher’s exact test were applied to compare the qualitative variables. Furthermore, binary logistic regression was used to find out the factors predicting the outcome of patients with acute digoxin poisoning. Totally, 81 patients with acute digoxin intoxication were enrolled in the study. Out of the 81 patients, nine patients (11.11%) were admitted to the ICUs. Four cases (4.9%) were intubated and underwent mechanical ventilation, and four subjects (4.9%) died. All the patients that were intubated or died had serum potassium level above normal ranges at the time of admission. In the logistic regression model (admission to ICU or ordinary wards), age, and high potassium level were found to be as an independent factor for adverse outcome (odd ratio=3.11, confidence interval=95%, 2.22-4.5, and odd ratio=12.2; confidence interval=95%, 10.1-14, respectively). In the present study, it was found that acute digoxin intoxication could result in worse outcomes. Moreover, it was noticed that in patients with higher age and abnormal potassium level, the incidence of morbidity and mortality is higher and requires more careful treatment.