aka Digoxin

The patient’s presentation is consistent with digoxin toxicity, and the best next step is to administer digoxin-specific antibody fragments. Digoxin is a cardiac glycoside that improves cardiac contractility in patients with poor cardiac output. Symptoms of toxicity include generalized fatigue, altered mental status, headaches, visual disturbances (e.g., yellow-tinted vision), and vomiting. Digoxin increases vagal tone and can cause sinus bradycardia, atrioventricular (AV) nodal dysfunction, and a high degree AV block. Bidirectional ventricular tachycardia is a classic ECG finding in digoxin toxicity. Indications for digoxin-specific antibody fragment administration are hyperkalemia (serum potassium > 5.5 mmol/L), ECG changes consistent with hyperkalemia, or life-threatening cardiac dysrhythmias. If digoxin-specific antibody fragments are not immediately available, temporizing measures to treat hyperkalemia may be administered until they become available.