Diagnosis and treatment of digoxin toxicity

Evaluation of Digoxin Concentration after Loading Dose in Patients with Renal Dysfunction

“…The following demographic and clinical data were collected: age, sex, weight, height, indication for treatment with digoxin, presence of concomitant therapies that could influence digoxin concentration or interfere with digoxin assays (amiodarone; propafenone; calcium-channel blockers such as verapamil, diltiazem, and nifedipine; quinidine; quinine; macrolide antibiotics, including clarithromycin, azithromycin, and erythromycin; tetracyclines; trimethoprim; or cyclosporine), 1,11 serum electrolyte values (potassium, magnesium, and calcium), 3,12 and baseline serum creatinine (i.e., the lowest recorded creatinine concentration during the admission). Acute kidney injury was defined according to modified RIFLE criteria: an increase in serum creatinine from baseline of at least 26.4 µmol/L or at least 150%-200% (1.5-to 2-fold).…”

A Baby Developing Digoxin Poisoning in Pediatric Intensive Care Unit: A Case Report

“…Yi ne de mut la ka ya pıl ma sı ge re ki yor sa en dü şük ener ji do zu ile ya pıl ma lı dır (16). Bi zim ol gu muz da di gok sin an ti ko ru uy gu la ma sı son ra sı EKG bul gula rı nın dü zel me si ve di gok sin kan dü ze yi nin düş -me si se be biy le ek te da vi ve ya gi ri şi me ih ti yaç duyul ma mış tır.…”

The Effectiveness of Digoxin in Treating Heart Failure

“…It is useful for patients with recent overdose, or in event where digoxin-specific antibody is not available, also no cardiac involvement [22]. Activated charcoal may increase clearance of digoxin by binding to digoxin in the intestinal lumen and gastrointestinal dialysis.…”

“…Digoxin-specific fab antibodies have high affinity for digoxin and will reverse its toxicity. Although, these antibodies are expensive, they are also proven most effective, for which studies have shown that 80% of patients have been completely resolved of all digoxin toxicity [22]. However, in the case of severe toxicity with cardiac involvement digoxin-specific fab fragment should be administered immediately [22].…”

“…Other drugs such as colestipol and cholestyramine will bind to digoxin in order to be eliminated from the system. Important to note, activated charcoal is unpalatably and can cause severe nausea, vomiting and a risk of aspiration, therefore, assessing the quantity and reason for the overdose is necessary [22]. Dosing rate exceeding 3.1 ng/ml^3 is considered therapeutic overdose, during which patients may present with both cardiac and extra cardiac manifestation [19].…”