Digoxin overdose

Last reviewed: 2 Nov 2022
Last updated: 13 Aug 2020

Summary

Definition

History and exam

Key diagnostic factors

  • digoxin exposure
  • gastrointestinal symptoms
  • central nervous system symptoms
  • visual symptoms
More key diagnostic factors

Other diagnostic factors

  • suicidality
  • cardiovascular symptoms
Other diagnostic factors

Risk factors

  • age >55 years
  • decreased renal clearance
  • hyperkalemia (>5.0 mEq/L)
  • hypokalemia (<3.0 to 3.5 mEq/L)
  • concomitant use of specific drugs
  • hypomagnesemia
  • hypercalcemia
  • hypothyroidism
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • digoxin serum concentration
  • serum potassium level
  • serum magnesium level
  • serum creatinine and BUN
More 1st investigations to order

Treatment algorithm

ACUTE

acute ingestion, low to moderate toxicity

chronic ingestion, low to moderate toxicity

severe toxicity or hemodynamic compromise (acute or chronic toxicity)

ONGOING

acute or chronic toxicity after initial treatment

Contributors

Authors

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

Disclosures

SP declares that he has no competing interests.

Acknowledgements

Dr Scott Phillips would like to gratefully acknowledge Dr Oladapo A. Odujube and Dr Robert S. Hoffman, previous contributors to this topic.

Disclosures

OAO and RSH declare that they have no competing interests.

Peer reviewers

Edward W. Boyer, MD

University of Massachusetts Medical School

Worcester

MA

Disclosures

EWB declares that he has no competing interests.

Ruben Thanacoody, MD, FRCP(Edin)

Consultant Physician and Clinical Toxicologist

National Poisons Information Service (Newcastle)

Newcastle-upon-Tyne

UK

Disclosures

RT declares that he has no competing interests.

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