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Suicide risk — USMLE Step 3 MCQ

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HardPsychiatry (outpatient management)Suicide riskUSMLE Step 3

A patient with CKD taking digoxin develops nausea, confusion, junctional bradycardia at 34/min, blood pressure 78/44 mm Hg and potassium 6.1 mEq/L. The last digoxin dose was taken 5 hours ago. What is the best antidotal treatment?

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Correct answer: B — Give digoxin immune Fab and provide continuous cardiac monitoring

The best answer is “Give digoxin immune Fab and provide continuous cardiac monitoring”. Hemodynamic instability, severe bradyarrhythmia and hyperkalemia establish life-threatening digoxin toxicity. Digoxin immune Fab should not be delayed for a level or renal elimination; dialysis removes little digoxin, and supportive measures do not replace the antidote. Life-threatening digoxin toxicity with unstable dysrhythmia, progressive bradycardia or clinically important hyperkalemia is treated with digoxin immune Fab; post-Fab total digoxin concentrations are not clinically interpretable.

Reference: FDA Prescribing Information: DIGIFAB: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=c05ee6a5-c98b-45f4-83fd-40781639d653&type=display