Classically produces an arrhythmia that could range from atrial tachycardia with AV delay, Bradycardia, junctional rhythm, alternating right and left AV nodal delay, ventricular arrhythmia
Alternating right and left BBB is one of the more specific arrhythmias for dig toxicity, although it’s not commonly seen.
Gastrointestinal
Patients often present with nausea/vomiting and abdominal pain
Most common side effects of digoxin toxicity
Rare complications include acute mesenteric ischemia
Elevation of digoxin level does not correlate with clinical manifestations
Leads to hypokalemia and low magnesium levels, which potentiates digoxin toxicity.
Hyperkalemia is a poor prognostic indicator for acute digoxin toxicity
Studies have shown that for patients with K >5.5, mortality was significantly higher
Patients with K<5, mortality was much less.
Primary treatment of patients with acute digoxin toxicity and hyperkalemia is Digoxin-specific antibody fragment (Fab)
It is generally recommended that you do not aggressively treat the hyperkalemia with agents such as calcium gluconate, bicarb, insulin/glucose as Fab will cause potassium to be lowered.
Giving these agents could actually cause hypokalemia
