Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-23T21:40:54.461Z Has data issue: false hasContentIssue false
  • English
  • Français

Serum digoxin concentrations and clinical signs and symptoms of digoxin toxicity in the paediatric population

Published online by Cambridge University Press:  27 April 2015

Brady S. Moffett ,
April Garner ,
Troy Zapata ,
Jeffrey Orcutt ,
Mary Niu  and
Keila N. Lopez
Brady S. Moffett*
Affiliation:
Department of Pharmacy, Texas Children’s Hospital, Houston, Texas, United States of America
April Garner
Affiliation:
Department of Pharmacy, Texas Children’s Hospital, Houston, Texas, United States of America
Troy Zapata
Affiliation:
Department of Pharmacy, Texas Children’s Hospital, Houston, Texas, United States of America
Jeffrey Orcutt
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Mary Niu
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Keila N. Lopez
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
*
Correspondence to: B. S. Moffett, Department of Pharmacy, Texas Children’s Hospital, 6621 Fannin St., Suite WB1120, Houston, TX 77030, United States of America. Tel: +832 824 6087; Fax: +832 825 5261; E-mail: bsmoffet@texaschildrens.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Serum digoxin levels have limited utility for determining digoxin toxicity in adults. Paediatric data assessing the utility of monitoring serum digoxin concentration are scarce. We sought to determine whether serum digoxin concentrations are associated with signs and symptoms of digoxin toxicity in children.

Methods

We carried out a retrospective review of patients <19 years of age who received digoxin and had serum digoxin concentrations assessed between January, 2007 and June, 2013. Data collection included patient demographics, digoxin indication, serum digoxin concentrations, signs and symptoms of digoxin toxicity, electrocardiograms, and co-morbidities. Reviewers performing chart review and electrocardiogram analysis were blinded to digoxin levels. Descriptive statistical methods were used and comparisons were made between patients with and without toxic serum digoxin concentrations (>2 ng/ml).

Results

There were 87 patients who met study criteria (male 46%, mean age 8.4 years). CHD was present in 67.8% and electrocardiograms were performed in 72.4% of the patients. The most common indication for digoxin toxicity was heart failure symptoms (61.5%). Toxic serum digoxin concentrations were present in 6.9% of patients (mean 2.6 ng/ml). Symptoms associated with digoxin toxicity occurred in 48.4%, with nausea/vomiting as the most common symptom (36.4%), followed by tachycardia (29.5%). Compared with those without toxic serum digoxin concentrations, significantly more patients with toxic serum digoxin concentrations were female (p=0.02). The presence of electrocardiogram abnormalities and/or signs and symptoms of digoxin toxicity was not significantly different between patients with and without serum digoxin concentrations (p>0.05).

Conclusion

Serum digoxin concentrations in children are not strongly associated with signs and symptoms of digoxin toxicity.

Keywords

Digoxinserum concentrationstoxicitypaediatrics
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 3 , March 2016 , pp. 493 - 498
Check for updates
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Gotsman, MS, Schrire, V. Toxicity–a frequent complication of digitalis therapy. S Afr Med J 1966; 40: 590–592.Google ScholarPubMed
2. Kanji, S, MacLean, RD. Cardiac glycoside toxicity: more than 200 years and counting. Crit Care Clin 2012; 28: 527–535.CrossRefGoogle Scholar
3. Wells, TG, Young, RA, Kearns, GL. Age-related differences in digoxin toxicity and its treatment. Drug Saf 1992; 7: 135–151.CrossRefGoogle ScholarPubMed
4. Berkovitch, M, Akilesh, MR, Gerace, R, et al. Acute digoxin overdose in a newborn with renal failure: use of digoxin immune fab and peritoneal dialysis. Ther Drug Monit 1994; 16: 531–533.CrossRefGoogle Scholar
5. Schmitt, K, Tulzer, G, Hackel, F, Sommer, R, Tulzer, W. Massive digitoxin intoxication treated with digoxin-specific antibodies in a child. Pediatr Cardiol 1994; 15: 48–49.CrossRefGoogle ScholarPubMed
6. Woolf, AD, Wenger, T, Smith, TW, Lovejoy, FH Jr. The use of digoxin-specific fab fragments for severe digitalis intoxication in children. N Engl J Med 1992; 326: 1739–1744.CrossRefGoogle ScholarPubMed
7. Iacuone, JJ. Accidental digitoxin poisoning. Am J Dis Child 1976; 130: 425–427.Google ScholarPubMed
8. Ordog, GJ, Benaron, S, Bhasin, V, Wasserberger, J, Balasubramanium, S. Serum digoxin levels and mortality in 5,100 patients. Ann Emerg Med 1987; 16: 32–39.CrossRefGoogle Scholar
9. Pickett, JR, Dickinson, ET. Dealing with DIG. A comprehensive review of digoxin and its therapeutic and toxic effects. JEMS 2005; 30: 70–78.Google ScholarPubMed
10. Hunt, SA, Abraham, WT, Chin, MH, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005; 112: e154–e235.Google Scholar
11. Koren, G, Parker, R. Interpretation of excessive serum concentrations of digoxin in children. Am J Cardiol 1985; 55: 1210–1214.CrossRefGoogle ScholarPubMed
12. Rutledge, J. Digitalis toxicity in infants and plasma digoxin levels. Pediatr Cardiol 1985; 6: 51–52.CrossRefGoogle ScholarPubMed
13. Fisch, C, Knoebel, SB. Digitalis cardiotoxicity. J Am Coll Cardiol 1985; 5: 91A–98A.CrossRefGoogle ScholarPubMed
14. Sundqvist, K, Atterhog, JH, Jogestrand, T. Effect of digoxin on the electrocardiogram at rest and during exercise in healthy subjects. Am J Cardiol 1986; 57: 661–665.CrossRefGoogle ScholarPubMed
15. Saner, HE, Lange, HW, Pierach, CA, Aeppli, DM. Relation between serum digoxin concentration and the electrocardiogram. Clin Cardiol 1988; 11: 752–756.CrossRefGoogle ScholarPubMed
16. Sanatani, S, Potts, JE, Reed, JH, et al. The Study of Antiarrhythmic Medications in Infancy (SAMIS): a multicenter, randomized controlled trial comparing the efficacy and safety of digoxin versus propranolol for prophylaxis of supraventricular tachycardia in infants. Circ Arrhythm Electrophysiol 2012; 5: 984–991.CrossRefGoogle Scholar
17. Rosenthal, D, Chrisant, MR, Edens, E, et al. International Society for Heart and Lung Transplantation: practice guidelines for management of heart failure in children. J Heart Lung Transplant 2004; 23: 1313–1333.CrossRefGoogle ScholarPubMed
18. Hastreiter, AR, van der Horst, RL, Chow-Tung, E. Digitalis toxicity in infants and children. Pediatr Cardiol 1984; 5: 131–148.CrossRefGoogle ScholarPubMed
19. Yang, EH, Shah, S, Criley, JM. Digitalis toxicity: a fading but crucial complication to recognize. Am J Med 2012; 125: 337–343.CrossRefGoogle ScholarPubMed
20. Bauman, JL, Didomenico, RJ, Galanter, WL. Mechanisms, manifestations, and management of digoxin toxicity in the modern era. Am J Cardiovasc Drugs 2006; 6: 77–86.CrossRefGoogle ScholarPubMed
21. Dec, GW. Digoxin remains useful in the management of chronic heart failure. Med Clin North Am 2003; 87: 317–337.Google ScholarPubMed
22. Koren, G, Hesslein, PS, MacLeod, SM. Digoxin toxicity associated with amiodarone therapy in children. J Pediatr 1984; 104: 467–470.CrossRefGoogle ScholarPubMed
23. Ratnapalan, S, Griffiths, K, Costei, AM, Benson, L, Koren, G. Digoxin-carvedilol interactions in children. J Pediatr 2003; 142: 572–574.CrossRefGoogle ScholarPubMed