Digoxin, Poisoning

Basics

Description

  • Acute digitalis effects (elevated levels in children and intentional overdose):
    • Inhibits sodium–potassium ATPase pump in cell membranes
    • Increased intracellular calcium
    • Increases K+ extracellularly
    • Increases vagal tone
    • Slows atrioventricular (AV) node conduction (vagotonic)
    • Increases automaticity and conduction system refractory period
    • Bradydysrhythmias
  • Chronic digitalis effects (therapeutic to toxic levels in elderly patients):
    • Inhibits sodium–potassium ATPase pump in cell membranes
    • Increases intracellular calcium
    • Increases vagal tone
    • Increases automaticity
    • Usually hypokalemic secondary to diuretic use
    • Tachydysrhythmias

Etiology

  • Digoxin/pharmaceuticals
  • Plants and animals containing cardiac glycosides:
    • Foxglove
    • Oleander (white and yellow)
    • Lily of the valley
    • Red squill
    • Cane toad, Colorado River toad

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