{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T12:51:42Z","timestamp":1759495902671,"version":"3.37.3"},"reference-count":20,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,1,8]],"date-time":"2018-01-08T00:00:00Z","timestamp":1515369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of the present study was to compare clinical features of patients with elevated serum digoxin concentrations who were treated with digoxin\u2010Fab with those where the immunotherapy was not given by a tertiary hospital toxicology service.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective series of patients with supratherapeutic serum digoxin concentrations referred to the toxicology service from August 2013 to October 2015. Data collected included demographics, presenting complaint, digoxin dose, other medications taken, serum digoxin, potassium and creatinine concentration on presentation and initial and post\u2010digoxin\u2010Fab heart rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 47 referrals. Digoxin\u2010Fab was administered in 21 cases. It was given more commonly when the heart rate was &lt;51\/min or serum potassium was &gt;5.0\u2009mmol\/L. Patients receiving digoxin\u2010Fab were more likely to be on maintenance therapy with beta\u2010blockers or calcium channel blockers (95% <jats:italic>vs<\/jats:italic> 61%; OR 13.1; 95% CI 1.5\u2013113) and\/or potassium\u2010sparing medications (95% <jats:italic>vs<\/jats:italic> 54%; OR 17.1; 95% CI 2.0\u2013147). They had elevated serum creatinine (76% <jats:italic>vs<\/jats:italic> 42%; OR 8.2; 95% CI 1.9\u201334), higher serum potassium (median: 5.1\u2009mmol\/L <jats:italic>vs<\/jats:italic> 4.2\u2009mmol\/L, <jats:italic>P<\/jats:italic>\u2009=\u20090.02), higher serum digoxin concentration (median: 3.5\u2009nmol\/L <jats:italic>vs<\/jats:italic> 2.3\u2009nmol\/L, <jats:italic>P<\/jats:italic>\u2009=\u20090.02) and pretreatment heart rate &lt;51\/min (66% <jats:italic>vs<\/jats:italic> 31%; OR 4.5; 95% CI 1.3\u201315). There were no patients with ventricular arrhythmias or hypotension. Median heart rate increased by 10\/min 1 and 4 h after digoxin\u2010Fab. However, individual heart rate response to digoxin\u2010Fab was variable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Digoxin\u2010Fab was more commonly administered when heart rate was &lt;51\/min. It had a small effect on increasing heart rate; however, individual response to digoxin\u2010Fab was variable as patients were using other negative chronotropic medications. In symptomatic bradycardic patients on multiple heart failure medications, positive chronotropic and potassium\u2010lowering therapies should be considered in concert with digoxin\u2010Fab.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1742-6723.12873","type":"journal-article","created":{"date-parts":[[2018,1,10]],"date-time":"2018-01-10T09:23:59Z","timestamp":1515576239000},"page":"242-248","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Elderly patients with suspected chronic digoxin toxicity: A comparison of clinical characteristics of patients receiving and not receiving digoxin\u2010Fab"],"prefix":"10.1111","volume":"30","author":[{"given":"Hooman","family":"Arbabian","sequence":"first","affiliation":[{"name":"Monash Clinical Toxicology Unit, Emergency Medicine Service Acute Medicine and Ambulatory Care Program, Monash Health  Melbourne, Victoria Australia"},{"name":"Emergency Department Dandenong Hospital, Monash Health  Melbourne, Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hwee Min","family":"Lee","sequence":"additional","affiliation":[{"name":"Monash Clinical Toxicology Unit, Emergency Medicine Service Acute Medicine and Ambulatory Care Program, Monash Health  Melbourne, Victoria Australia"},{"name":"Emergency Department Dandenong Hospital, Monash Health  Melbourne, Victoria Australia"},{"name":"Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health Monash University  Melbourne, Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0310-3983","authenticated-orcid":false,"given":"Andis","family":"Graudins","sequence":"additional","affiliation":[{"name":"Monash Clinical Toxicology Unit, Emergency Medicine Service Acute Medicine and Ambulatory Care Program, Monash Health  Melbourne, Victoria Australia"},{"name":"Emergency Department Dandenong Hospital, Monash Health  Melbourne, Victoria Australia"},{"name":"Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health Monash University  Melbourne, Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,1,8]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_7_2_1","DOI":"10.1097\/MD.0000000000002949"},{"doi-asserted-by":"publisher","key":"e_1_2_7_3_1","DOI":"10.1007\/s00228-016-2026-0"},{"doi-asserted-by":"publisher","key":"e_1_2_7_4_1","DOI":"10.1056\/NEJMsa1103053"},{"doi-asserted-by":"publisher","key":"e_1_2_7_5_1","DOI":"10.1073\/pnas.57.1.71"},{"doi-asserted-by":"publisher","key":"e_1_2_7_6_1","DOI":"10.1056\/NEJM197604082941501"},{"doi-asserted-by":"publisher","key":"e_1_2_7_7_1","DOI":"10.1056\/NEJM198211253072201"},{"doi-asserted-by":"publisher","key":"e_1_2_7_8_1","DOI":"10.3109\/15563658508990641"},{"doi-asserted-by":"publisher","key":"e_1_2_7_9_1","DOI":"10.1016\/S0735-1097(85)80471-X"},{"doi-asserted-by":"publisher","key":"e_1_2_7_10_1","DOI":"10.1161\/01.CIR.81.6.1744"},{"doi-asserted-by":"publisher","key":"e_1_2_7_11_1","DOI":"10.1016\/0735-6757(91)90162-D"},{"doi-asserted-by":"publisher","key":"e_1_2_7_12_1","DOI":"10.1016\/S0735-1097(10)80170-6"},{"doi-asserted-by":"publisher","key":"e_1_2_7_13_1","DOI":"10.7326\/0003-4819-119-4-199308150-00004"},{"doi-asserted-by":"publisher","key":"e_1_2_7_14_1","DOI":"10.1007\/s00134-008-1092-x"},{"doi-asserted-by":"publisher","key":"e_1_2_7_15_1","DOI":"10.3109\/15563659309000392"},{"doi-asserted-by":"publisher","key":"e_1_2_7_16_1","DOI":"10.1097\/MEJ.0b013e3283207fce"},{"key":"e_1_2_7_17_1","first-page":"587","article-title":"Treatment of chronically digoxin\u2010poisoned patients with a newer digoxin immune fab\u2010\u2010a retrospective study","volume":"110","author":"Schaeffer TH","year":"2010","journal-title":"J. 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