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digoxin toxicity

Probability of digoxin toxicity being the cause of the symptoms

  • bradycardia alone ⇒ 10% if serum digoxin 1.9nmol/L & 50% if serum digoxin 3.2nmol/L
  • GI symptoms alone ⇒ 25% if serum digoxin 1.9nmol/L & 60% if serum digoxin 3.2nmol/L
  • GI symptoms + bradycardia ⇒ 60% if serum digoxin 1.9nmol/L & 90% if serum digoxin 3.2nmol/L
  • automaticity alone ⇒ 70% if serum digoxin 1.9nmol/L & 90% if serum digoxin 3.2nmol/L
  • automaticity plus bradycardia or GI symptoms ⇒ >80% if serum digoxin 1.9nmol/L & 100% if serum digoxin 3.2nmol/L
  • NB. 1.9nmol/L = 1.5ng/ml; 3.2nmol/L = 2.5ng/ml;
  • NB. normal Rx range 6hrs or more after last dose: 0.6-1.3nmol/L = 0.5-1.0ng/ml

Indications for Digibind (Fab fragments) generally include:

  • dysrhythmias associated with hemodynamic instability.
  • altered mental status attributed to digoxin toxicity.
  • hyperkalaemia with K+ greater than 5 mEq/L.
  • serum digoxin level greater than 10 ng/mL in adults at steady state (ie, 6-8 h post acute ingestion or at baseline in the clinical setting of chronic toxicity).
  • ingestion greater than 10 mg in adults (40 X 0.25 mg tablets) or greater than 0.3 mg/kg in children.

Mx of broad complex tachycardia in digoxin toxicity:

Cardiac arrest in digoxin toxicity

  • standard drug measures are futile
  • initiate CPR as per usual while 5 ampoules Digibind are sourced and administered iv - this may be life saving!
  • continue CPR for at least 30min after administration of Digibind before considering termination of CPR as being futile.
oddigoxin.txt · Last modified: 2009/02/04 13:29 (external edit)