DIGOXIN TOXICITY IN THERAPEUTIC SERUM LEVELS

Öz

Aim:The purpose of this study, to evaluate digoxin toxicity and risk factors leading to digoxin toxicity in patients with therapeutic digoxin levels.

Material and Methods: We studied ninety–five patients with digoxin level was above of the 1.4 ng/mL and below of the 2.0 ng/mL at admission. They were divided into two groups, drug toxicity or nontoxicity, on the basis of both clinical symptoms and electrocardiography recording. The clinical and laboratory data were compared between these groups.

Results: When overall patients’ digoxin usage indications were evaluated, it was revealed that 56 patients (58.9%) had been received digoxin only for heart failure, 32 patients (33.6%) only for atrial fibrillation and 20 patients (21%) received digoxin for both conditions. The exact reason for digoxin usage could not be determined in 17 patients (17.9%). When patients were evaluated, no differences in age, gender, medical history other than coronary artery disease and laboratory findings were observed between toxic and nontoxic patients. The medical history of coronary artery disease in toxic patients was significantly higher than in nontoxic patients (p: 0.008). In these variable, no differences were observed except atrial fibrillation (p<0.001), between toxic and nontoxic patients.

Conclusion: In this study, the exact reasons for digoxin use could not be determined in 17 (17.9%) patients. In appropriate usage of digoxin could be increased risk of adverse outcomes and education program may reduce in appropriate use. Clinicians should be aware that signs of toxicity may occur at levels below of the 2.0 ng/mL, and such toxicity is more likely in the presence of atrial fibrillation or coronary artery disease.

Keywords: Digoxin, toxicity, intoxication, serum digoxin levels

Anahtar Kelimeler

• Digoxin, toxicity, intoxication, serum digoxin levels

ÖZGÜN MAKALE/ORIGINAL ARTICLE

Öz

Amaç: Bu çalışmanın amacı terapötik seviyede digoksin seviyesi olan hastalarda digoksin toksisitesi ve risk faktörlerini araştırmak. Metot: Başvuru sırasında digoksin seviyesi 1,4 ng/mL’nin üzerinde ve 2,0 ng/mL’nin altında olan 95 hasta klinik belirti ve elektrokardiyografi kayıtları göz önüne alınarak toksisite olan ve toksisite olmayan olarak iki gruba ayrıldı. Klinik ve laboratuar verileri iki grup arasında karşılaştırıldı. Bulgular: Tüm hastalar digoksin kullanma endikasyonu açısından değerlendirildiğinde 56 hasta (58,9%) sadece sol kalp yetersizliği, 32 hasta (33,6%) atriyal fibrilasyon ve 20 hasta (21%) her iki durum için kullanıyorlardı. 17 hastada (17,9%) ise digoksin kullanımının net bir nedeni, bulunamadı. Toksik ve toksik olmayan grup arasında yaş, cinsiyet, koroner arter hastalığı dışındaki medikal öykü ve laboratuar bulguları açısından fark yoktu. Sadece koroner arter hastalığı öyküsü anlamlı şekilde toksik grupta fazla saptandı (p:0,008). Atriyal fibrilasyon (p<0,001) dışında toksik ve toksik olmayan hastalar arasında fark yoktu. Sonuç: Bu çalışmada 17 (17,9%) hastada digoksin kullanımı için net bir endikasyon saptanamamıştır. Uygunsuz digoksin kullanımı istenmeyen yan etkilerin artışına sebep olabilir ve eğitim programları uygunsuz kullanımı azaltabilir. Klinisyenler toksisite belirtilerinin 2,0 ng/mL’nin altında olabileceğinin farkında olmalı ve toksisite koroner arter hastalığı öyküsü ve atriyal fibrilasyon varlığında daha olasıdır

Anahtar Kelimeler

• Digoksin, toksisite, intoksikasyon, serum digoksin düzeyleri

Kaynakça

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