Background
In acute poisoning based on ingested digoxin dose |
– Adults: > 10 mg in healthy adults, with a lower threshold in patients with renal insufficiency or underlying heart disease* – Children: > 4 mg (or > 0.1 mg/kg) |
In acute and chronic poisoning based on clinical features |
– Haemodynamic instability or life-threatening dysrhythmia, with elevated steady-state serum digoxin concentration > 2.6 nmol/l (2 ng/ml) a. Progressive (severe) sinus bradycardia (40–60/min) or second- or third-degree heart block unresponsive to atropine b. Increased automaticity (e.g. multiple ventricular ectopics or supraventricular tachyarrhythmias), severe ventricular tachycardia or ventricular fibrillation – Presence of manifestations of digoxin toxicity along with serum potassium > 5.0 mmol/l (5 mEq/l) a. Hyperkalaemia (K > 5.0 mmol/l) is a clinical marker for acute digoxin toxicity requiring treatment. This criterion may not be useful in chronic toxicity for several reasons, e.g. renal failure, or drugs interfering with the homeostatic mechanisms for excretion of potassium through the renin/angiotensin/aldosterone axis |
In acute and chronic poisoning based on serum digoxin concentrations |
– Independent of clinical features: a. Serum digoxin concentration ≥ 13 nmol/l (10 ng/ml) soon after ingestion in acute poisoning b. Serum digoxin concentration > 10 nmol/l (7.8 ng/ml) 6 h post-ingestion c. Serum digoxin concentration > 7.7 nmol/l (6 ng/ml) in chronic poisoning (adults) d. Serum digoxin concentration > 5.1 nmol/l (4 ng/ml) in chronic poisoning (children) |