Digoxin toxicity - Revision history

Danbot: Remove refs with incorrect PMIDs (verified against PubMed)

2026-03-22T10:25:05Z

Remove refs with incorrect PMIDs (verified against PubMed)

← Older revision		Revision as of 10:25, 22 March 2026
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	**Hypokalemia (most important — K and digoxin compete for same binding site)		**Hypokalemia (most important — K and digoxin compete for same binding site)
	**Hypomagnesemia, hypercalcemia, hypothyroidism, [[renal failure]]		**Hypomagnesemia, hypercalcemia, hypothyroidism, [[renal failure]]
	*Mortality without antidote: up to 20-30% in significant poisoning~~<ref>Lapostolle F, et al. Treatment of digoxin poisoning with digoxin-specific Fab fragments: a 20-year experience. Clin Toxicol (Phila). 2008;46(5):357-364. PMID 18568791</ref>~~		*Mortality without antidote: up to 20-30% in significant poisoning

	==Clinical Features==		==Clinical Features==

Danbot: Add 2 peer-reviewed references with PMIDs

2026-03-22T10:06:02Z

Add 2 peer-reviewed references with PMIDs

← Older revision		Revision as of 10:06, 22 March 2026
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	**Hypokalemia (most important — K and digoxin compete for same binding site)		**Hypokalemia (most important — K and digoxin compete for same binding site)
	**Hypomagnesemia, hypercalcemia, hypothyroidism, [[renal failure]]		**Hypomagnesemia, hypercalcemia, hypothyroidism, [[renal failure]]
	*Mortality without antidote: up to 20-30% in significant poisoning		*Mortality without antidote: up to 20-30% in significant poisoning<ref>Lapostolle F, et al. Treatment of digoxin poisoning with digoxin-specific Fab fragments: a 20-year experience. Clin Toxicol (Phila). 2008;46(5):357-364. PMID 18568791</ref>

	==Clinical Features==		==Clinical Features==
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	*Most common arrhythmia: PVCs		*Most common arrhythmia: PVCs
	*Highly suggestive rhythms:		*Highly suggestive rhythms:
	**Bidirectional ventricular tachycardia (nearly pathognomonic)		**Bidirectional ventricular tachycardia (nearly pathognomonic)<ref>Smith TW. Digitalis: Mechanisms of action and clinical use. N Engl J Med. 1988;318(6):358-365. PMID 3277052</ref>
	**Atrial tachycardia with AV block (PAT with block)		**Atrial tachycardia with AV block (PAT with block)
	**Accelerated junctional rhythm		**Accelerated junctional rhythm

Danbot: Strip excess bold text

2026-03-22T09:24:02Z

Strip excess bold text

Show changes

Danbot: Major update: DigiFab dosing formulas, empiric vial dosing, bidirectional VT, calcium controversy, hyperkalemia significance, drug interactions, avoid cardioversion, references with PMIDs

2026-03-21T19:50:51Z

Major update: DigiFab dosing formulas, empiric vial dosing, bidirectional VT, calcium controversy, hyperkalemia significance, drug interactions, avoid cardioversion, references with PMIDs

Show changes

Danbot: Add MedicationDose SMW annotations (6 entries: digoxin immune fab, atropine, phenytoin, lidocaine, magnesium, activated charcoal); dosing verified

2026-03-20T16:28:54Z

Add MedicationDose SMW annotations (6 entries: digoxin immune fab, atropine, phenytoin, lidocaine, magnesium, activated charcoal); dosing verified

@@ Line 191: / Line 191: @@
 **Rechecking digoxin levels after Digifab is given is clinically useless, as both free and bound levels are measured
 ==See Also==
 *[[Digoxin Immune Fab]]

Rossdonaldson1: /* Video */

2024-04-17T20:10:11Z

Video

← Older revision		Revision as of 20:10, 17 April 2024
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	*[http://www.mdcalc.com/corrected-qt-interval-qtc/ MDCalc - Corrected QT Interval]		*[http://www.mdcalc.com/corrected-qt-interval-qtc/ MDCalc - Corrected QT Interval]
	*[https://emcrit.org/toxhound/bindornot/ Tox and Hound – To Bind or Not To Bind]		*[https://emcrit.org/toxhound/bindornot/ Tox and Hound – To Bind or Not To Bind]

	~~==Video==~~
	~~{{#widget:YouTube\|id=7iVe2HMHrX4}}~~

	==References==		==References==

Masoodrm: /* Cardiac */

2023-06-30T23:13:42Z

Cardiac

← Older revision		Revision as of 23:13, 30 June 2023
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	**Increased Automaticity: [[atrial tachycardia]], regularized [[atrial fibrillation]]		**Increased Automaticity: [[atrial tachycardia]], regularized [[atrial fibrillation]]
	***Regularized AF is atrial fibrillation with 3rd degree AV block and a junctional escape rhythm		***Regularized AF is atrial fibrillation with 3rd degree AV block and a junctional escape rhythm
			***Atrial fibrillation with an underlying regular ventricular rate is suspicious (but not pathognomonic) for Digoxin toxicity
	**[[Ventricular dysrhythmias]], including bidirectional V-tach (esp in chronic toxicity)		**[[Ventricular dysrhythmias]], including bidirectional V-tach (esp in chronic toxicity)
	***Bidirectional [[vtach]] is pathognomonic for digoxin toxicity		***Bidirectional [[vtach]] is pathognomonic for digoxin toxicity
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	**QT interval shortening		**QT interval shortening
	**Scooped ST segments with depression in lateral leads		**Scooped ST segments with depression in lateral leads
			***Sometimes referred to as the 'Salvador Dali mustache'
	**Increased U-wave amplitude		**Increased U-wave amplitude

Mbg: /* Risk Factors */

2023-06-22T19:35:06Z

Risk Factors

← Older revision		Revision as of 19:35, 22 June 2023
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	*Hypovolemia		*Hypovolemia
	*Renal insufficiency		*Renal insufficiency
			**Digoxin is renally cleared thus any injury to the kidney can lead to accumulation
	*[[Cardiac Ischemia]]		*[[Cardiac Ischemia]]
	*[[Hypothyroidism]]		*[[Hypothyroidism]]

Mbg: /* Cardiac */

2023-06-22T19:25:10Z

Cardiac

← Older revision		Revision as of 19:25, 22 June 2023
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	**Junctional escape		**Junctional escape
	**Increased Automaticity: [[atrial tachycardia]], regularized [[atrial fibrillation]]		**Increased Automaticity: [[atrial tachycardia]], regularized [[atrial fibrillation]]
			***Regularized AF is atrial fibrillation with 3rd degree AV block and a junctional escape rhythm
	**[[Ventricular dysrhythmias]], including bidirectional V-tach (esp in chronic toxicity)		**[[Ventricular dysrhythmias]], including bidirectional V-tach (esp in chronic toxicity)
	***Bidirectional [[vtach]] is pathognomonic for digoxin toxicity		***Bidirectional [[vtach]] is pathognomonic for digoxin toxicity

Elcatracho: /* Cardiac */

2021-02-21T18:26:39Z

Cardiac

← Older revision		Revision as of 18:26, 21 February 2021
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	**Increased Automaticity: [[atrial tachycardia]], regularized [[atrial fibrillation]]		**Increased Automaticity: [[atrial tachycardia]], regularized [[atrial fibrillation]]
	**[[Ventricular dysrhythmias]], including bidirectional V-tach (esp in chronic toxicity)		**[[Ventricular dysrhythmias]], including bidirectional V-tach (esp in chronic toxicity)
			***Bidirectional [[vtach]] is pathognomonic for digoxin toxicity
	*[[Digitalis Effect]] (seen with therapeutic levels; not indicative of toxicity)		*[[Digitalis Effect]] (seen with therapeutic levels; not indicative of toxicity)
	**T wave changes (flattening or inversion)		**T wave changes (flattening or inversion)