Digoxin toxicity

Non-cardiac symptoms of Digoxin toxicity include:

• a) CNS and GIT symptoms

• b) Respiratory and Renal symptoms

• c) Musculoskeletal and Dermatological symptoms

• d) Hepatic and Endocrine symptoms

A key lab finding that strongly suggests severe Digoxin toxicity is:

• Hyponatremia

• Hyperkalemia

• Hypokalemia

• Hypercalcemia

A patient is considered "clinically toxic" if their Digoxin level, drawn at least 6 hours

• above 0.5 ng/ml

• above 1 ng/ml

• above 2 ng/ml

• above 5 ng/ml

...... and ...... can exacerbate CAS cardiotoxicity, even at "therapeutic" digoxin concentration:

• Hypocalcemia, Hypophosphatemia

• Hypernatremia, Hypocalcemia

• Hypomagnesemia, Hypernatremia

• Hyperkalemia, Hypokalemia

Prior to the introduction of DSFab, ....... was used for supraventricular bradydysrhythmias, and ....... was used for ventricular tachydysrhythmias:

• Lidocaine, Amiodarone

• Atropine, phenytoin

• Lidocaine,Atropine

• Propranolol, Phenytoin

Although ......... is beneficial in most hyperkalemia patients, in the setting of CAS poisoning, it is considered potentially

• Insulin

• Glucose

• Sodium Bicarbonate

• Calcium

Gastrointestinal decontamination is rarely performed for digoxin poisoning because:

• It increases the risk of aspiration

• It is generally ineffective against CAS

• Rapid absorption of the drug

• can induce fatal arrhythmias

When treating digoxin toxicity, multi-dose ...... can be administered 1g/kg body weight every 2-4 hours (to enhance elimination):

• Digoxin-specific Fab (DSFab)

• Kayexalate

• Activated Charcoal (AC)

• Sodium Bicarbonate

Digoxin toxicity is often manifested by conduction problems between the:

• SA and AV nodes

• AV node and Bundle of His

• Bundle of His and Purkinje fibers

• SA node and atrial muscle

In non-life-threatening cases, .......... administration generally should be withheld until the hypokalemia is corrected because the cardiotoxicity often resolves when the potassium is normalized:

• Atropine

• digoxin-specific Fab (DSFab)

• Activated Charcoal

• Phenytoin