Digoxin overdose - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Digoxin overdose can be acute or chronic, intentional, or accidental.
Typically presents with components of gastrointestinal, constitutional, and/or cardiovascular symptoms.
Diagnosis is based on symptoms and laboratory data. At therapeutic digoxin doses (0.5 to 0.9 nanograms/mL), the ECG typically shows PR-interval prolongation and a scooped ST segment. In overdose, ECG also shows signs of increased automaticity (premature ventricular contractions), atrioventricular nodal blockade, and slowed ventricular response.
Treatment includes digoxin-specific antibody fragments and supportive care. Lidocaine and phenytoin can be used for cardiac dysrhythmias when antibody fragments are unavailable.
There are no long-term complications of poisoning in patients treated appropriately for chronic digoxin toxicity, as long as anoxic brain injury, myocardial infarction, or terminal dysrhythmias have not occurred prior to treatment.

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Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

Gheorghiade M, van Veldhuisen DJ, Colucci WS. Contemporary use of digoxin in the management of cardiovascular disorders. Circulation. 2006 May 30;113(21):2556-64.[Abstract]
Smith TW, Haber E, Yeatman L, et al. Reversal of advanced digoxin intoxication with Fab fragments of digoxin-specific antibodies. N Engl J Med. 1976 Apr 8;294(15):797-800.[Abstract]
Smith TW, Butler VP Jr, Haber E, et al. Treatment of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments: experience in 26 cases. N Engl J Med. 1982 Nov 25;307(22):1357-62.[Abstract]
Bismuth C, Gaultier M, Conso F, et al. Hyperkalemia in acute digitalis poisoning: prognostic significance and therapeutic implications. Clin Toxicol. 1973;6(2):153-62.[Abstract]
Taboulet P, Baud FJ, Bismuth C, et al. Acute digitalis intoxication--is pacing still appropriate? J Toxicol Clin Toxicol. 1993;31(2):261-73.[Abstract]

Referenced Articles

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43. Taboulet P, Baud FJ, Bismuth C, et al. Acute digitalis intoxication--is pacing still appropriate? J Toxicol Clin Toxicol. 1993;31(2):261-73.[Abstract]
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