- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Part 15.1 Principles of management
- Part 15.2 Management of specific poisons
- Chapter 317 Management of salicylate poisoning
- Chapter 318 Management of acetaminophen (paracetamol) poisoning
- Chapter 319 Management of opioid poisoning
- Chapter 320 Management of benzodiazepine poisoning
- Chapter 321 Management of tricyclic antidepressant poisoning
- Chapter 322 Management of poisoning by amphetamine or ecstasy
- Chapter 323 Management of digoxin poisoning
- Chapter 324 Management of cocaine poisoning
- Chapter 325 Management of β-blocker and calcium channel blocker poisoning
- Chapter 326 Management of cyanide poisoning
- Chapter 327 Management of alcohol poisoning
- Chapter 328 Management of carbon monoxide poisoning
- Chapter 329 Management of corrosive poisoning
- Chapter 330 Management of pesticide and agricultural chemical poisoning
- Chapter 331 Management of radiation poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 1540) Management of digoxin poisoning
- Chapter:
- (p. 1540) Management of digoxin poisoning
- Author(s):
Frédéric Lapostolle
and Stephen W. Borron
- DOI:
- 10.1093/med/9780199600830.003.0323
Despite a gradual decline in the clinical use of digitalis glycosides, digitalis toxicity continues to be responsible for substantial morbidity and mortality, particularly among the elderly. Digitalis poisoning may occur acutely, after intentional overdose, but is more often seen as the result of chronic intoxication among patients receiving digitalis therapy. Clinical findings in chronic digitalis poisoning are often subtle. The astute clinician will enquire about digitalis use in older patients with vague complaints and will not be dissuaded from considering digitalis toxicity in the face of a ‘therapeutic’ digitalis blood concentration. Two digitalis preparations continue to be used with frequency, depending on geography. Digoxin is the digitalis glycoside of choice in the USA, while digitoxin prevails in some parts of Europe. While the methods and half-lives of elimination differ markedly for these two substances, the approach to poisoning by either is similar. Advanced age, underlying cardiovascular disease, and severe hyperkalaemia represent poor prognostic factors in digitalis poisoning. Early administration of digitalis Fab fragments should be undertaken when life-threatening symptoms are present. Prophylactic therapy with reduced doses of Fab fragments should be strongly considered for less serious toxicity.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Part 15.1 Principles of management
- Part 15.2 Management of specific poisons
- Chapter 317 Management of salicylate poisoning
- Chapter 318 Management of acetaminophen (paracetamol) poisoning
- Chapter 319 Management of opioid poisoning
- Chapter 320 Management of benzodiazepine poisoning
- Chapter 321 Management of tricyclic antidepressant poisoning
- Chapter 322 Management of poisoning by amphetamine or ecstasy
- Chapter 323 Management of digoxin poisoning
- Chapter 324 Management of cocaine poisoning
- Chapter 325 Management of β-blocker and calcium channel blocker poisoning
- Chapter 326 Management of cyanide poisoning
- Chapter 327 Management of alcohol poisoning
- Chapter 328 Management of carbon monoxide poisoning
- Chapter 329 Management of corrosive poisoning
- Chapter 330 Management of pesticide and agricultural chemical poisoning
- Chapter 331 Management of radiation poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care