Toxin:: [[Digoxin toxicity]] # Indications ## Acute digoxin overdose * Cardiac arrest * Life-threatening cardiac dysrhythmia * Ingested dose >10 mg (adult) or >4 mg (child) * Serum digoxin level >15 nmol/L (12 ng/mL) * Serum potassium >5 mmol/L ## Chronic digoxin poisoning * Cardiac arrest * Life-threatening cardiac dysrhythmia * Cardiac dysrhythmia or increased automaticity not likely to be tolerated for a prolonged period * Moderate-to-severe gastrointestinal symptoms * Any symptoms in presence of impaired renal function ## Other cardiac glycoside poisoning - Oleander - Bufotoxin (cane toad) # Dose ## Acute digoxin overdose - \# of amps = ingested dose (mg) x 0.8 (bioavailability) x2 - unknown dose: - give 5 amps if stable or 10 amps if unstable - rpt dose 5 ams Q30 min until reversal of digoxin tox achieved ## chronic digoxin poisoning \# of amps = (serum digoxin (ng/mL) x body weight (kg) )/100 or give emperic 2 amps and observe. if no reversal of digoxin tox after 30 min, given another 2 amps # Endpoints - restoration of normal cardiac rhythm and conduction - resolution of gastro symptoms