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Digoxin, Poisoning, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Acute digitalis effects (elevated levels in children and intentional overdose):

    • Inhibits sodium-potassium ATPase pump in cell membranes

    • Allows more calcium ions to enter cell and cardi...

Diagnosis

Signs and Symptoms

  • Toxicity onset: 2 hr after PO ingestion and 15 min following IV

  • Toxicity:

    • Occurs with normal digoxin levels (chronic)

    • May be absent with elevated digoxin levels (acute)

  • Cardiov...

Treatment

Pre-Hospital

  • Establish IV access

  • Continuous cardiac monitoring

  • Apply pads for potential cardioversion

  • If cardioversion is necessary for tachydysrhythmias, use low levels (50 J)

  • May precipitate re...

Follow-Up

Disposition

Admission Criteria

  • ICU:

    • Unstable cardiovascular status in acute or chronic toxicity

  • Telemetry:

    • Asymptomatic or mildly symptomatic dysrhythmia

    • High risk for developing toxicity

Discharge Criteria

Pearls and Pitfalls

When it is known that the patient is on digoxin and presents with cardiovascular instability, and/or hyperkalemia, treatment should begin with the antidote: Digoxin-specific Fab fr...

Additional Reading

  • Erickson  CP, Olson  KR. Case files of the medical toxicology fellowship of the California poison control system-San Francisco: calcium plus digoxin-more taboo than toxic? J Med Tox...

Codes

ICD9

972.1 Poisoning by cardiotonic glycosides and drugs of similar action 

ICD10

  • T46.0X1A Poisoning by cardi-stim glycos/drug simlar act, acc, init

  • T46.0X4A Poisoning by cardi-stim glycos/drug siml...

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