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Digoxin Poisoning 4/11/10 PY Mindmaps PY ICU Drug Book - 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) - psychiatric assessment if deliberate acute renal failure change medications genetic predisposition iatrogenic Jeremy Fernando (2011)