physiology of cardiac glycosides

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mechanism of action of digoxin

pharmacokinetics of digoxin

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digoxin intoxication 
other cardiac glycosides

clinical manifestations

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acute vs. chronic toxicity
a variety of arrhythmias may be seen:

EKG features

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1) some uncommon arrhythmias may particularly suggest the possibility of digoxin toxicity

2) EKG revealing digitalis effect

3) Paced EKGs

differential diagnosis

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common differential diagnostic considerations:
related differential diagnoses

digoxin levels

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when to check a digoxin level:
timing of the digoxin level
interpretation of the digoxin level in digoxin intoxication
interpretation of the “digoxin level” in intoxication with other cardiac glycosides


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digoxin-specific antibody fragments (DSFab)

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💡Assess need for DSFab early and order promptly, because the time delay from ordering to clinical benefit is generally at least ~2 hours.  

potential complications from DSFab


hemodynamic stabilization

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volume resuscitation

electrolyte management

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questions & discussion

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To keep this page small and fast, questions & discussion about this post can be found on another page here.

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Going further


  • 04715199  Bismuth C, Gaultier M, Conso F, Efthymiou ML. Hyperkalemia in acute digitalis poisoning: prognostic significance and therapeutic implications. Clin Toxicol. 1973;6(2):153-62. doi: 10.3109/15563657308990513  [PubMed]
  • 22998989  Kanji S, MacLean RD. Cardiac glycoside toxicity: more than 200 years and counting. Crit Care Clin. 2012 Oct;28(4):527-35. doi: 10.1016/j.ccc.2012.07.005  [PubMed]
  • 26505271  Roberts DM, Gallapatthy G, Dunuwille A, Chan BS. Pharmacological treatment of cardiac glycoside poisoning. Br J Clin Pharmacol. 2016 Mar;81(3):488-95. doi: 10.1111/bcp.12814  [PubMed]
  • 27041802  Pincus M. Management of digoxin toxicity. Aust Prescr. 2016 Feb;39(1):18-20. doi: 10.18773/austprescr.2016.006  [PubMed]
  • 28217235  Bressman M, Repplinger D, Slater W, Patt M. Electrophysiologic similarities of overdose between digoxin and bufadienolides found in a Chinese aphrodisiac. J Arrhythm. 2017 Feb;33(1):76-78. doi: 10.1016/j.joa.2016.05.004  [PubMed]
  • 28572865  Muñoz NL, Buendía AB, Manterola FA. Electrocardiographic Changes After Suicidal Digoxin Intoxication in a Healthy Woman. Open Cardiovasc Med J. 2017 May 16;11:58-60. doi: 10.2174/1874192401711010058  [PubMed]
  • 33476509  Lucyk S. Calculated decisions: DigiFab® (Digibind®) Dosing for Digoxin Poisoning. Emerg Med Pract. 2020 Sep 15;22(Suppl 9):CD1-CD3. PMID: 33476509  [PubMed]