#EMConf: Digoxin Toxicity


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 



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



  • 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


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


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