Narrow therapeutic window: 

• 0.5-0.8 ng/mL to treat heart failure
• 0.8 - 2.0 ng/mL to treat atrial fibrillation

Toxic levels: > 2.0 ng/mL 

ACUTE: 

• Hyperkalemia = predictor of POOR outcome 
• Treat as normally would - give IV Caclium 
• Cardiac effects = bradydysrhythmias, AV blocks
• Digoxin specific antibodies: 10-20 vials 

CHRONIC: 

• Associated w/ increase dose or decrease renal excretion
• Hypokalemia worsens toxicity
• correct for K > 4
• Cardiac effects = ventricular dysrhythmias
• Digoxin specific antibodies: 2-4 vials 

Keywords associated with Digoxin Toxicity you may seen on the boards: 

• visual changes w/ YELLOW halos 
• SLOW atrial fibrillation
• BIDIRECTIONAL Vtach

If you missed the earlier post on Digoxin basics, click here. 

Reference: 

Levine, Michael, and Aaron Skolnik.. "Digitalis Glycosides." Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill