What is dig toxicity and how do you treat it?

Answer 1

Digoxin, also called digitalis, is a cardiac glycosides that is used in the management of congestive heart failure (CHF) and heart rhythm problems (atrial arrhythmias). Digoxin has a narrow therapeutic index which makes it prone to causing toxicity. To expand on what a narrow therapeutic index means further, it describes a drug whose level in the blood has a narrow window that is acceptable. If the drug is outside of that window (either higher or lower), then the drug can either be ineffective or toxic. 

During your assessment of a patient with suspected dig toxicity, you should determine the agent taken, the amount taken, the time of ingestion, and any other drugs they took at the same time. The ideal time to draw a digoxin concentration level is at least six hours after ingestion which is why it is important to determine what time your patient took it last. It is also important to determine if the patient is prescribed digoxin and normally takes it or if they took someone else medication. Patients can have chronic digitalis toxicity or an acute presentation. In either situation, cardiac effects are of the greatest concern. Other typical symptoms with acute ingestion include GI symptoms after several hours including nausea, vomiting, and abdominal pain. You will also see electrolyte abnormalities and neurologic manifestations often. Some patients, especially those with chronic toxicity, may present with visual changes such as alterations in color vision, specifically xanthopsia (objects appear yellow). While this is classically associated with digitalis toxicity, it does not always occur.

If you suspect a patient may have digoxin toxicity, a serum digoxin concentration, serum potassium concentration, creatinine and BUN, and serial electrocardiograms (ECG) should be obtained. A quantitative serum digoxin concentration is therapeutic when in the range of 0.8-2 ng/mL (1-2.6 nmol/L). If a patient has clinically significant manifestations of digitalis toxicity (life-threatening arrhythmias, evidence of end-organ dysfunction, hyperkalemia), they can be treated with digoxin-specific antibody (Fab) fragments. If Fab fragments are not immediately available,  bradycardia can be treated with atropine and hypotension with IV boluses of isotonic crystalloid. Patients suspected of having acute digitalis intoxication who present to the emergency department within one to two hours of ingestion may benefit from the administration of activated charcoal. 

Answer 2

"Dig toxicity" Digoxin toxicity is a life-threatening condition. The most common symptoms are gastrointestinal and include nausea, vomiting, abdominal pain and diarrhea. The cardiac manifestations are the most concerning and can be fatal. Digitalis is a medicine that is used to treat certain heart conditions. Digitalis toxicity can be a side effect of digitalis therapy. It may occur when you take too much of the drug at one time. It can also occur when levels of the drug build up for other reasons such as other medical problems you have.

The most common prescription form of this medicine is called digoxin. Digitoxin is another form of digitalis.Digitalis toxicity can be caused by high levels of digitalis in the body. A lower tolerance to the drug can also cause digitalis toxicity. People with lower tolerance may have a normal level of digitalis in their blood. They may develop digitalis toxicity if they have other risk factors.

People with heart failure who take digoxin are commonly given medicines called diuretics. This drugs remove excess fluid from the body. Many diuretics can cause potassium loss. A low level of potassium in the body can increase the risk of digitalis toxicity. Digitalis toxicity may also develop in people who take digoxin and have a low level of magnesium in their body.

You are more likely to have this condition if you take digoxin, digitoxin, or other digitalis medicines along with drugs that interact with it. Some of these drugs are quinidine, flecainide, verapamil, and amiodarone.

If your kidneys do not work well, digitalis can build up in your body. Normally, it is removed through the urine. Any problem that affects how your kidneys work (including dehydration) makes digitalis toxicity more likely. VERY IMPORTANT to ask the person if herbal supplements or "Natural" remedies are used.

Some plants contain chemicals that can cause symptoms similar to digitalis toxicity if they are eaten. These include foxglove, oleander, and lily of the valley.