Digoxin toxicity | |
---|---|
Other names | Digoxin poisoning, digoxin overdose |
Drawings of Digitalis purpurea | |
Specialty | Emergency medicine |
Symptoms | vomiting, loss of appetite, confusion, blurred vision, changes in color perception, decreased energy[1] |
Complications | Heart dysrhythmia[1] |
Causes | Excessive digoxin, plants such as foxglove[1][2] |
Risk factors | Low potassium, low magnesium, high calcium[1] |
Differential diagnosis | Acute coronary syndrome, hyperkalemia, hypothyroidism, beta blocker toxicity[2] |
Treatment | Supportive care, activated charcoal, atropine, digoxin-specific antibody fragments[2][1] |
Frequency | ~2,500 cases per year (US)[2] |
Digoxin toxicity, also known as digoxin poisoning, is a type of poisoning that occurs in people who take too much of the medication digoxin or eat plants such as foxglove that contain a similar substance.[1][2] Symptoms are typically vague.[1] They may include vomiting, loss of appetite, confusion, blurred vision, changes in color perception, and decreased energy.[1] Potential complications include an irregular heartbeat, which can be either too fast or too slow.[1]
Toxicity may occur over a short period of time following an overdose or gradually during long-term treatment.[1] Risk factors include low potassium, low magnesium, and high calcium.[1] Digoxin is a medication used for heart failure or atrial fibrillation.[3] An electrocardiogram is a routine part of diagnosis.[2] Blood levels are only useful more than six hours following the last dose.[1]
Activated charcoal may be used if it can be given within two hours of the person taking the medication.[1] Atropine may be used if the heart rate is slow while magnesium sulfate may be used in those with premature ventricular contractions.[2] Treatment of severe toxicity is with digoxin-specific antibody fragments.[1] Its use is recommended in those who have a serious dysrhythmia, are in cardiac arrest, or have a potassium of greater than 5 mmol/L.[1] Low blood potassium or magnesium should also be corrected.[1] Toxicity may reoccur within a few days after treatment.[1]
In Australia in 2012 there were about 140 documented cases.[1] This is a decrease by half since 1994 as a result of decreased usage of digoxin.[1] In the United States 2500 cases were reported in 2011 which resulted in 27 deaths.[2] The condition was first described in 1785 by William Withering.[4]