Digoxin toxicity
| Digoxin poisoning | |
|---|---|
| Synonyms | digoxin toxicity |
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| Digitalis purpurea drawings by Franz Köhler | |
| Classification and external resources | |
| Specialty | emergency medicine |
| ICD-10 | T46.0 |
| ICD-9-CM | 972.1 |
| MedlinePlus | 000165 |
Digoxin poisoning, also known as digoxin toxicity, is a type of poisoning that may occur in people who take too much of the drug digoxin in a short period of time or in those who accumulate high levels of digoxin in their blood during long-term treatment. Digoxin (derived from foxglove plants of the genus Digitalis) is a medication prescribed to people with heart failure and/or atrial fibrillation.
Digoxin toxicity is often divided into acute or chronic toxicity. In both of these toxicity, cardiac effects are of the greatest concern. With an acute ingestion, symptoms such as nausea, vertigo, and vomiting are prominent. On the other hand, nonspecific symptoms are more predominate in chronic toxicity. These symptoms include fatigue, malaise, and visual disturbances.
The classic features of digoxin toxicity are nausea, vomiting, diarrhea, abdominal pain, headache, dizziness, confusion, delirium, vision disturbance (blurred or yellow vision). It is also associated with cardiac disturbances including irregular heartbeat, ventricular tachycardia, ventricular fibrillation, sinoatrial block and AV block.
In individuals with suspected digoxin toxicity, a serum digoxin concentration, serum potassium concentration, creatinine, BUN, and serial electrocardiograms is obtained.
In digoxin toxicity, the finding of frequent premature ventricular beats (PVCs) is the most common and the earliest dysrhythmia. Sinus bradycardia is also very common. In addition, depressed conduction is a predominant feature of digoxin toxicity. Other ECG changes that suggest digoxin toxicity include bigeminal and trigeminal rhythms, venticular bigeminy, and bidirectional ventricular tachycardia.
The level of digoxin for treatment is typically 0.5-2 ng/mL. Since this is a narrow therapeutic index, digoxin overdose can happen. A serum digoxin concentration of 0.5-0.9 ng/mL among those with heart failure is associated with reduced heart failure deaths and hospitalizations. It is therefore recommended that digoxin concentration be maintained in approximately this range if it is used in heart failure patients.
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