First-line treatment for serious toxicity
Consult expert advice.
The indications for a more energetic approach to digoxin toxicity include:
- persistent nausea with vomiting
- heart block
- heart failure
- cardiac arrhythmia
The management includes:
- intravenous potassium:
- 40 mmol potassium in 5% dextrose over 1 hr
- ECG monitoring throughout
- potassium is stopped if sinus rhythm returns or there are signs of hyperkalaemia e.g. peaked T waves
- a total of 120 mmol may be given
- if initial potassium levels were normal, then the risk of hyperkalaemia is reduced if the potassium is infused in 250 ml of 20% dextrose with 30 U of soluble insulin
- intravenous magnesium:
- magnesium protect the myocardium
- give 50 ml of 2% magnesium sulphate over 1 hr
- repeat infusion as required
- activated charcoal p.o.
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