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Digoxin, Poisoning Updated 12/2010

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BASICS

  • Description
  • Etiology

DIAGNOSIS

  • Signs and Symptoms
  • Essential Workup
  • Tests
  • Differential Diagnosis

TREATMENT

  • Pre-hospital
  • Initial Stabilization
  • ED Treatment
  • Medication (Drugs)
  • In-patient Considerations

Ongoing Care

  • Follow-Up Recommendations
The following is an excerpt....
BASICS
Description
  • Acute digitalis effects (elevated levels in children and intentional overdose):
    • Inhibits sodium-potassium ATPase pump in cell membranes
    • Allows more calcium ions to enter cell and cardiac cells to contract more strongly
    • Increases K+ extracellularly
    • Increases vagal tone
    • Slows atrioventricular (AV) node conduction (vagotonic)
    • Increases automaticity and conduction system refractory period
    • Bradydysrhythmias
  • Chronic digitalis effects (therapeutic to toxic levels in elderly patients):
    • Inhibits sodium-potassium ATPase pump in cell membranes
    • Increases intracellular calcium
    • Increases vagal tone
    • Increases automaticity
    • Usually hypokalemic secondary to diuretic use
    • Tachydysrhythmias
Etiology
  • Digoxin/digitoxin pharmaceuticals
  • Plants and animals containing cardiac glycosides:
    • Foxglove
    • Oleander
    • Lily of the valley
    • Dogbane
    • Red squill
    • Cane toad, Colorado River toad

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