Download Digoxin Poisoning

Digoxin Poisoning
4/11/10
PY Mindmaps
PY ICU Drug Book
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commonly used to treat atrial arrhythmias
useful in controlling ventricular rate in patients with left ventricular systolic dysfunction
weak inotropic, neurohumoral and vagomimetic effects
narrow therapeutic index
CLINICAL FEATURES
- CVS: arrhythmias, sinus bradycardia, AF, atrial flutter, AF with AV block, conduction
dysfunction, ventricular ectopic beats
- GI: anorexia, nausea, vomiting, diarrhoea, abdominal pain
- CNS: lethargy, confusion, weakness, headache, delirium, psychosis, photophobia, blurred
vision, decreased visual acuity, coloured halo’s around lights
- METABOLIC: hyperkalaemia
INVESTIGATIONS
- digoxin level: can be mis-leading and needs to interpreted in the context of presenting
symptoms given it displays two compartment pharmacokinetics (fast absorption then slow
distribution)
- therapeutic range = 0.6-1.2nmol/L
- sample @ 8-24 hours post dose
- if started in ICU only measure level @ 5-7 days
MANAGEMENT
Resuscitation
-
ACLS protocol as indicated
activated charcoal
induced emesis not recommended
supportive care of dysrhythmias + digoxin immune Fab
Electrolytes and Acid-base Balance
- hyperkalaemia -> indication for digoxin immune Fab
Specific Therapy
- digoxin immune Fab
- number of vials = (serum digoxin concentration – ng/L) x (weight – kg)  100
Underlying Cause
Jeremy Fernando (2011)
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psychiatric assessment if deliberate
acute renal failure
change medications
genetic predisposition
iatrogenic
Jeremy Fernando (2011)