skip to main content

Digoxin toxicity – DigiFab — RACP Paediatrics MCQ

Instant feedback + full explanation. One question, done properly.

HardEmergencyDigoxin toxicity – DigiFabRACP Paediatrics

A 3-year-old has acute digoxin ingestion with vomiting, haemodynamic instability, bidirectional ventricular tachycardia and potassium 6.5 mmol/L. Which treatment most directly reverses the toxin-mediated arrhythmia?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Administer digoxin-specific immune Fab with poisons-centre guidance

Explanation lettering: D = shown as B · E = shown as C · B = shown as D · C = shown as E

C is correct. Life-threatening arrhythmia, shock and hyperkalaemia after digoxin exposure are indications for digoxin-specific immune Fab, the toxin-specific antidote listed by RCH. D can temporise selected symptomatic bradyarrhythmias but cannot neutralise digoxin or treat bidirectional VT. E treats sodium-channel blockade and is not a digoxin antidote. A is used principally for severe beta-blocker or calcium-channel-blocker poisoning. B may stabilise myocardium in other hyperkalaemic states but does not bind digoxin and must not delay Fab or specialist toxicology advice. Airway support, continuous ECG, electrolytes and early Poisons Information Centre consultation accompany antidote administration.

Reference: Royal Children’s Hospital Melbourne: Poisoning—acute guidelines for initial management: https://www.rch.org.au/clinicalguide/guideline_index/Poisoning_-_Acute_Guidelines_For_Initial_Management/