Daily Critical Care Pearls #58:
Digoxin Toxicity - Part 1
📌 The drug has a narrow therapeutic window, but there is not always correlation between the digoxin level and toxicity
📌 Some patients may have a level in the toxic range and be asymptomatic and some may be in the therapeutic range but experience toxicity
📌 A level collected before 4 hours has elapsed from ingestion may not represent an accurate level and could be falsely elevated - 4 to 6 hours post ingestion allows for distribution and a more accurate level
📌 Common rhythms seen in digoxin toxicity are: Premature ventricular contractions, Bradycardia, Atrial tacharrhtymia with AV block, Ventricular bigeminy Junctional rhythm, AV block, Ventricular tachycardia, Ventricular fibrillation
📌 Acute toxicity may involve the patient being assymptomatic after ingestion for a few hours followed by severe GI symptoms such as nausea, vomiting, abdominal pain, and anorexia
📌 Visual disturbances are also characteristic of toxicity but the classic finding of xanthopsia where everything appears yellow is often missing
📌 Hyperkalemia in acute toxicity is both a marker of toxicity and a predictor of mortality
#criricalcare #pharmacy #medicine #clinicalpharmacy #pearls