Digoxin is widely prescribed however toxicity is rare in comparison, the main route of elimination is via the kidneys
Occurs in overdose of digoxin but more commonly occurs in elderly patients with deteriorating renal function.
Bradycardia Hypotension, cardiogenic shock
Lethargy, Xanthopsia (yellow vision), nausea, vomiting and dizziness
Bloods: Digoxin level, magnesium, U+E’s
ECG: ‘reverse tick’ sign, bradycardia, AV block, AF, paroxysmal atrial tachycardia, VT, VF
Stop digoxin
Cardiac monitoring
Digibind
A temporary pacing wire may be required
Depends on comorbidities and age
Bradycardias, AV block, atrial tachycardia with 2:1 block, bidirectional VT.
Digoxin can also initiate AF in patients with a normal sinus rhythm
