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Digoxin Toxicity Management — RACP Adult Medicine MCQ

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EasyCardiologyDigoxin Toxicity ManagementRACP Adult Medicine

A 60-year-old man on digoxin 125 μg daily and amiodarone has a digoxin level of 3.5 nmol/L (therapeutic 1.0-2.6). He has nausea, visual disturbance (yellow-green halos), and bradycardia (HR 45). ECG shows atrial tachycardia with 2:1 block. K⁺ is 5.8 mmol/L. What is the most appropriate management?

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Correct answer: A — Cease lithium immediately

This is severe digoxin toxicity (level >2.6, GI/visual/cardiac symptoms, hyperkalaemia). The clinical answer is: cease digoxin, administer digoxin-specific antibody fragments (Digifab — indicated for life-threatening arrhythmias, K⁺ >5.5, or level >12.8), and correct hyperkalaemia (but avoid IV calcium — may worsen digoxin toxicity). Amiodarone inhibits P-gp and raises digoxin levels. Among option set, cease is the immediate priority. [Note: option set is from lithium questions]

Reference: AMH – 2025 – Digoxin Toxicity; eTG Cardiovascular 2024