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Pulmonary embolism — SCE Acute Medicine MCQ

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HardRespiratory medicinePulmonary embolismSCE Acute Medicine

An 82-year-old taking digoxin for atrial fibrillation presents with confusion, vomiting and bradycardia. Potassium is 6.1 mmol/L, creatinine 245 micromol/L and ECG shows complete heart block with broad escape complexes. The digoxin concentration is 4.0 micrograms/L. What is the priority antidotal treatment?

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

Reveal the answer and explanation

Correct answer: B — Give digoxin-specific antibody fragments now with urgent toxicology/cardiology support and monitoring

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

E is correct. Complete heart block, hyperkalaemia and systemic toxicity are life-threatening manifestations and warrant digoxin-specific Fab; treatment is driven by clinical severity rather than an isolated concentration. A ignores multiple high-risk findings. B does not neutralise digoxin, and the historical fear of calcium should not distract from definitive antidote treatment. C may be needed if bradyarrhythmia persists but pacing can be hazardous and is not a substitute for Fab. D is not sufficient in established severe toxicity and may be inappropriate long after ingestion. Potassium, rhythm and renal function require close monitoring after Fab.

Reference: NHS Specialist Pharmacy Service: digoxin monitoring: https://www.sps.nhs.uk/monitorings/digoxin-monitoring/