Clinical Characteristics Of Digoxin Intoxication In 26 Children

Objective :To study the clinical features of digoxin intoxication in children and contribute to the early recognition and appropriate treatment.Methods:Clinical data from patients of digoxin intoxication admitted from January 1990 to December 2015 according to inclusion and exclusion criteria were retrospectively analyzed, divided which into ingestion group and therapeutic group depending on the aim and the reason, the ingestion group except the 2 patients with heart basic disease were divided into 2parts depending on whether blood purification(BP) or not.Collected data containing clinical manifestation,lab examination,electrocardiogram(ECG),treatment and the prognosis and summed up experiences.Results : 1.In a total of 26 patients,20 cases were divided into ingestion group,15 were younger than 3 years old.6 cases were divided into therapeutic group with the age ranging from 4 months and 9 days to 8 years and 9 months.2.ECG transform,heart rate decrease and arrhythmia were the most common and severe manifestations of digoxin intoxication.96.2% patients had the abnormal ECG, with 69.2% chronic arrhythmia and the most common form of was conduction block(61.5%).Of the 26 patients 3(11.5%)patients had premature ventricular contraction.The ECG of 3 patients became more severe during the hospitalization. 70.0% of ingestion group had decreased heart rate and 35.0% had arrhythmia.3.The non cardiac symptoms of digoxin intoxication mainly containedalimentary canal symptoms(96.2%) and neurologic symptoms(100.0%).vomiting was most common(88.5%),and 80.8% were with the onset of vomiting,while only one(3.8%)patient had diarrhea.God wilt(61.5%) and drowsiness(34.6%) were usually seen with no color vision.4.For the Serum digoxin concentration( SDC), > 2ng/ml of the ingestion group accounted for 80.0%,>4ng/ml 60%,and ≤2ng/ml 10%. 3patients in the therapeutic group were with the concentration of 0.8 ~2ng/ml,2 of which had hypokalemia, 2 patients in the therapeutic group were with the concentration of > 2ng/ml, 2.6ng/ml and 3.85ng/ml respectively,both of which with the abnormal kidney function.5.Nine patients in the ingestion group underwent BP,compared with non BP group,BP can accelerate the excretion of overdose digoxin(P <0.05).6.In the ingestion group,the symptoms disappearing time need 4days(2 ~ 6),the ECG recovering time need 4 days(1 ~ 9).11.5% patients died out of digoxin intoxication within 36 hours after mistaking ingestion,the first one died 12 hours after ingestion.Conclusion : Digoxin intoxication had poor prognosis and high mortality,within 36 hours the state may progress rapidly and should be closely observed.Mistaking ingestion is the most common reason of digoxin intoxication in children and younger than 3 years old should be cared for well.Arrhythmia was the most severe and common manifestation mainly with chronic arrhythmia.For long-time digoxin user we must moniter ECG, electrolyte and the kidney function.Serum digoxin concentration is crucial to diagnose and tratment the digoxin accidental intoxication.The blood pu rification can accelerate the excretion of digoxin.