Slow infusion (ie, 2 hours) improves digoxin immune Fab efficacy. The calculator is appropriate for vials containing approximately 40 mg of antibodies. Impaired creatinine clearance and aging (associated with decreased function of renal, hepatic, and cardiac systems) may result in clinical toxicity at lower serum digoxin levels.Įlectrolyte abnormalities (specifically hypokalemia, but including hypomagnesemia, hypercalcemia, hypernatremia) may result in dysrhythmias at lower serum digoxin levels.Ĭertain medications, including quinidine, verapamil, diltiazem, carvedilol, amiodarone, and spironolactone, will result in decreased digoxin protein binding, thereby increasing free digoxin levels. Correcting mild elevations in serum potassium without administering digoxin immune Fab will not improve survival. Hyperkalemia acts as a marker of poisoning severity in acute digoxin overdose. If required, free digoxin levels will need to be measured (this is not readily available at all labs). The serum digoxin level may be misleadingly high if obtained < 6 hours after ingestion.ĭigoxin levels measured after administration of digoxin immune Fab will be falsely elevated. Cardioactive steroid toxicity can cause nearly any dysrhythmia except rapidly conducted supraventricular tachydysrhythmia.Ĭonsider the serum digoxin level in the context of the patient’s clinical presentation a reliable serum digoxin level must be obtained at steady state (ie, obtained ≥ 6 hours after ingestion).
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