Cardiac glycosides; electrolyte disturbances, digoxin antibody indications, managment.

1. Cardiac Glycosides Part II
javier benitez (@jvrbntz)
In 5 slides or less...

2. Case Presentation
Older man with multiple comorbidities
including heart failure presents to the
emergency department with nausea, acute
shortness of breath, chest discomfort,
weakness, and confusion.
The patient is on multiple medications
including a cardiac glycoside. After a careful
history and physical exam you suspect cardiac
glycoside toxicity.

3. 1. Discuss the electrolyte disturbances associated
with cardiac glycosides toxicity and their
management.
2. List indications for digoxin-specific antibody
administration.
3. What's the medical (Rx) treatment for unstable
dysrhythmia associated with digoxin toxicity.

4. 1. Cardiac glycoside acute toxicity is associated with
hyperkalemia and increased mortality. The usual
treatment of hyperkalemia does not reduce mortality.
Digoxin-specific ab will redistribute potassium back into
the cells. Manifestation during chronic toxicity include
hypokalemia, hypomagnesemia, hypercalcemia, especially
with long term use of diuretics, diarrhea, and vomiting.
Potassium should be replenished as it may worsen with
administration of digoxin antibody.
2. Indications for digoxin-specific antibody
administration include: life threatening arrhythmia,
presence of end organ failure, hyperkalemia, digoxin
level.
3. Unstable dysrhythmias may be treated with digoxin
antibody. Lidocaine or phenytoin may be given if digoxin
antibody is not available.

5. Reference
Cardiac Glycoside Toxicity More Than 200
Years and Counting
Salmaan Kanji, PharmD, Robert D. MacLean, PharmD
Critical Care Clinics - Volume 28, Issue 4 (October 2012)