- Teaching Points:
- Clinical Manifestations
- Neurologic
- Can present with confusion, lethargy, coma, etc
- Vision abnormalities can be seen
- Patients can develop yellow vision
- Cardiac
- Most dangerous side effects
- 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
- Neurologic
- Elevation of digoxin level does not correlate with clinical manifestations
- Digoxin toxicity commonly occurs in decompensated heart failure patients undergoing aggressive diuresis
- 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
- Clinical Manifestations
SCVMC IM Chief Resident Blog 