A patient on digoxin with chronic heart failure is vomiting, has yellow-tinged vision and a potassium of 2.9 mmol/L. The ECG shows atrial tachycardia with block. What is the specific treatment for life-threatening toxicity?
Answer and explanation
Correct answer: A. Digoxin-specific antibody fragments
- Step 1: Hypokalaemia increases digoxin binding to the Na/K ATPase and so provokes toxicity. Step 2. Antibody fragments bind digoxin and are given for arrhythmias or very high levels, with potassium corrected and the heart monitored. Answer: Digoxin-specific antibody fragments. Why not the others: Calcium is avoided in digoxin toxicity because of the theoretical risk of arrhythmia. Digoxin has a large volume of distribution and is poorly dialysable. Flumazenil is a benzodiazepine antagonist.
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