Digoxin Toxicity

Question 1

What are common signs and symptoms of digoxin toxicity?

Answer 1

• Dizziness
• Nausea and vomiting
• Diarrhoea
• Anorexia
• Palpitations
• Syncope
• Blurred vision
• Yellow-green discolouration of vision
• Visual haloes
• Confusion

None

Question 2

What ECG findings are associated with digoxin toxicity?

Answer 2

• Reverse tick sign of downsloping ST depression
• Flattened, inverted or biphasic T waves
• Shortened QT interval

None

Question 3

What dysrhythmias may occur in digoxin toxicity?

Answer 3

• Supraventricular tachycardias
• Atrioventricular block
• Frequent premature ventricular contractions
• Sinus bradycardia
• Slow atrial fibrillation
• Ventricular tachycardia

None

Question 4

What investigations should be conducted in suspected digoxin toxicity?

Answer 4

• Venous blood gas for potassium level
• Capillary blood glucose
• Digoxin level
• U&Es for renal function and electrolytes
• Magnesium level
• Bone profile for calcium levels
• Full blood count and CRP

None

Question 5

What is the preferred treatment for hyperkalaemia in digoxin toxicity?

Answer 5

Insulin-dextrose

None

Question 6

What management steps should be taken for digoxin toxicity?

Answer 6

• A to E approach to initial resuscitation
• Activated charcoal if ingestion within 1 hour
• Continuous cardiac monitoring for arrhythmias
• Correct electrolyte abnormalities
• Administer DigiBind or DigiFab in severe cases
• Use atropine for bradyarrhythmias if antidote not available
• Magnesium sulphate as adjunct in tachyarrhythmias
• Refer for psychiatry input after recovery in intentional overdose cases

None

Question 7

Fill in the blank: A common sign of digoxin toxicity is _______.

Answer 7

Confusion

None

Question 8

True or False: Atrioventricular block can occur in digoxin toxicity.

Answer 8

True

None

Question 9

What should be monitored continuously in cases of digoxin toxicity?

Answer 9

Cardiac rhythms

None

Question 10

What is the significance of magnesium levels in digoxin toxicity?

Answer 10

Hypomagnesaemia increases digoxin toxicity

None

Question 11

What is the risk associated with a digoxin level of 1.5 to 3 mcg/L?

Answer 11

Increased likelihood of toxicity

None