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Digoxin ToxicityAka: Digitalis Toxicity, Digibind, Digoxin-Immune Fab

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  1. Epidemiology
    1. Digoxin Toxicity is common (Incidence 7-20%)
  2. Risk Factors
    1. Hypokalemia
    2. Hypomagnesemia
    3. Hypercalcemia
    4. Medication use interfering with Digoxin excretion
      1. Quinidine
      2. Verapamil
      3. Amiodarone
  3. Symptoms
    1. Anorexia
    2. Nausea
    3. Vomiting
    4. Somnolence
    5. Muscle Weakness
    6. Diarrhea
    7. Yellow vision (xanthopsia)
  4. Labs
    1. Serum Digoxin Level over 2.5 mg/ml
      1. Does not always correlate with toxicity
      2. Toxicity may occur at low levels and not at high ones
    2. Electrocardiogram
      1. Dysrhythmia
        1. Premature beats
        2. Bigeminy
        3. Paroxysmal Atrial Tachycardia with 2:1 AV Block
        4. Atrial Fibrillation
        5. Nodal rhythm
        6. Ventricular Tachycardia
      2. T Wave inversion
      3. ST Depression
      4. PR interval increased
  5. Management
    1. Stop Digoxin
    2. Correct Hypokalemia
      1. Use caution if Heart Block is present
    3. Treat associated arrhythmias appropriately
    4. Avoid potentially harmful interventions
      1. Catecholamines
      2. Electrical Cardioversion
        1. Safe if Digoxin Level is under 2 ng/ml
        2. Use lowest possible energy if needed (10-20 J)
    5. Digibind (40 mg/vial)
      1. Indications
        1. Massive Digoxin overdose
        2. Refractory Digitalis toxicity
      2. Calculate vials needed based on Digoxin level
      3. Vials = (Digoxin Level in ng/ml) x (WtKg)/100

Digitalis Toxicity (C0012254)

ConceptsInjury or Poisoning (T037)
EnglishDigitalis Toxicity
Parent ConceptsDrug toxicity (C0013221)
SourcesCOSTAR, MTH, NCI
Derived from the NIH UMLS (Unified Medical Language System)


Poisoning by digoxin (C0274727)

ConceptsInjury or Poisoning (T037)
ICD9972.1
EnglishDigoxin poisoning, Digoxin toxicity, Poisoning by digoxin
Spanishintoxicacion por digoxina, toxicidad por digoxina
Parent ConceptsPoisoning by cardiac rhythm regulator (C0412873), Poisoning by cardiotonic glycoside (C0412877)
SourcesMTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Digibind (C0687706)

ConceptsAmino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129)
MSHC050199
EnglishDigibind
SourcesMSH, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)



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