Digoxin Intoxication

Diagitalis toxicity to occurs in 5-20% of all patients being treated with cardiac glycosides. The single most frequent cause of intoxication is the concurrent administeration of diuretics that cause depletion of potassium. Digoxin toxicity often presents with gastrointestinal side effects such as anorexia, nausea or vomiting (45% of patients with life threatening toxicity present with nausea or vomiting). Other side effects include cardiac dysrhythmias, Neurologic effects (e. g.; visual disturbances and drowsiness). However the most dangerous side effect is arrhythmia, which could be fatal if gone untreated. The most common arrhythmia associated with digoxin toxicity is ventricular bigeminy. Digoxin toxicity risk factors include drug overdose, diuretic therapy, decreased renal function, dialysis, hypercalcemia (due to bed rest, myeloma, parathyroid disorders, etc.), hypomagnesaemia and hypothyroidism. Treatment that is usually successful, is consisted of ECG monitoring, discontinuing digoxin and diuretics, treatment of arrhythmia (lidocaine), potassium administration (if initial serum potassium is not high) and finally using digoxin immune FAB fragment (Digibind) in life threatening states.