Early Recognition of Digoxin Toxicity Is Essential
See how digoxin can lead to potentially life-threatening toxicity and understand signs and symptoms to look for.
Early recognition of potentially life-threatening digoxin toxicity may result in improved treatment outcomes.1,2
- Signs of potentially life-threatening digoxin toxicity include life-threatening or hemodynamically unstable cardiac
dysrhythmias, hyperkalemia, and evidence of end-organ dysfunction from hypoperfusion.2 - Cardiac effects are of the greatest concern in patients with digoxin toxicity.2
Don't miss the signs of potentially life-threatening digoxin toxicity
Signs of digoxin toxicity include:
Cardiac Dysrhythmias3,4
- Severe ventricular dysrhythmias
- Progressive bradydysrhythmias
- Ventricular tachydysrhythmias are more common in chronic or late acute digoxin toxicity5
- Early bradydysrhythmias in acute toxicity are often responsive to atropine5
- Bradydysrhythmias in chronic or late acute digoxin toxicity are often minimally responsive to atropine5
Laboratory Parameters2,3
- Severely elevated serum potassium concentrations with rapidly progressive signs and symptoms
- Severely elevated serum digoxin concentrations with clinically significant signs and symptoms
- Hyperkalemia (e.g., >5.5 mEq/L in adults or >6 mEq/L in children) frequently occurs in acute digoxin toxicity and is an important predictor of mortality3,5
- Severely elevated digoxin levels (e.g., steady-state concentrations >6 ng/mL in adults or >4 ng/mL in children) can lead to potentially life-threatening toxicity3
Evidence of End-Organ Dysfunction2
- Signs and symptoms of end-organ dysfunction from hypoperfusion
- Signs and symptoms include renal failure, altered mental status, abdominal pain2
Any ONE
may indicate the need for
IMMEDIATE INTERVENTION2,3
Digoxin toxicity can occur at therapeutic concentrations and levels do not always correlate with clinical manifestations.
- In acute ingestions, obtaining an immediate digoxin concentration in patients with toxicity does not necessarily correlate with toxicity severity and can be misleading, as clinical manifestations are a result of tissue penetration that often lags behind peak serum concentrations6,7
- Chronic digoxin toxicity may occur at typical therapeutic digoxin concentrations due to electrolyte imbalance or drug-drug interactions2,5,6
Review clues that may point to potentially life-threatening digoxin toxicity and the importance of immediate intervention.