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Digoxin toxicity with instability — RACP Adult Medicine MCQ

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HardClinical pharmacology and toxicologyDigoxin toxicity with instabilityRACP Adult Medicine

An 81-year-old woman taking digoxin for atrial fibrillation presents with nausea, confusion and visual disturbance. ECG shows bradyarrhythmia with ventricular ectopy, potassium is 6.1 mmol/L and digoxin concentration is markedly elevated. What is the most appropriate management?

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Correct answer: C — Give digoxin-specific antibody fragments

Life-threatening digoxin toxicity with hyperkalaemia and arrhythmia requires digoxin-specific antibody fragments. Calcium is not the antidote and does not remove digoxin effect. More digoxin, verapamil or minimal observation would be dangerous.

Reference: Australian Medicines Handbook; Poisons Information Centre guidance