Digoxin toxicity

Last reviewed: 3 Nov 2022
Last updated: 31 Jan 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • digoxin exposure
  • gastrointestinal symptoms
  • central nervous system symptoms
  • visual symptoms
Full details

Other diagnostic factors

  • suicidality
  • cardiovascular symptoms
Full details

Risk factors

  • age >55 years
  • decreased renal clearance
  • hyperkalaemia (>5.0 mmol/L)
  • hypokalaemia (<3.0 to 3.5 mmol/L)
  • concomitant use of specific drugs
  • hypomagnesaemia
  • hypercalcaemia
  • hypothyroidism
Full details

Diagnostic investigations

1st investigations to order

  • ECG
  • serum digoxin concentration
  • serum potassium level
  • serum magnesium level
  • serum creatinine and urea
  • Blood glucose
Full details

Treatment algorithm

ACUTE

acute, acute on chronic, or chronic toxicity

ONGOING

stable after initial treatment

Contributors

Expert advisers

Euan A. Sandilands, MBChB, BSc(Hons), MD, FRCP Edin

Consultant Clinical Toxicologist

Director

National Poisons Information Service (Edinburgh)

Royal Infirmary of Edinburgh

Edinburgh

UK

Disclosures

EAS declares that he has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:

Scott Phillips, MD

Associate Clinical Professor of Medicine

Department of Clinical Pharmacology and Toxicology

University of Colorado

Denver

CO

Associate Medical Director

Washington Poison Center

Seattle

WA

Peer reviewers

Ruben Thanacoody, MD, FRCP(Edin)

Director NPIS (Newcastle)

Regional Drugs and Therapeutics Centre

Newcastle upon Tyne Hospitals NHS Trust

Newcastle upon Tyne

UK

Disclosures

RT declares that he has no competing interests.

Editors

Emma Quigley

Section Editor, BMJ Best Practice

Disclosures

EQ declares that she has no competing interests.

Tannaz Aliabadi-Oglesby

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Adam Mitchell

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Julie Costello

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

  • Differentials

    • Beta-blocker toxicity
    • Calcium-channel blocker toxicity
    • Hypothermia
    More Differentials
  • Guidelines

    • Self-harm: assessment, management and preventing recurrence
    • TOXBASE: digoxin
    More Guidelines
  • Patient leaflets

    Heart attack: what is it?

    What you can do to prevent another heart attack

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer