[A patient with severe digoxin toxicity].

Area of Science:

• Cardiology
• Clinical Toxicology

Background:

• Digoxin, a cardiac glycoside, is commonly used for atrial fibrillation and heart failure.
• Digoxin toxicity presents with symptoms including nausea, hyperkalemia, arrhythmias, and cardiac arrest.
• Treatment involves reducing absorption, managing electrolyte imbalances, symptom management, and digoxin antibody administration for severe cases.

Observation:

• A 73-year-old male with advanced cardiac disease ingested 20 mg of digoxin.
• The patient developed ventricular fibrillation within 3 hours of ingestion, prior to digoxin antibody administration.
• Despite resuscitation efforts and partial antibody treatment, the patient deceased.

Findings:

• The national supply of digoxin antibodies in the Netherlands was insufficient for this severe toxicity case.
• Delayed administration of digoxin antibodies contributed to the adverse outcome.

Implications:

• A greater supply and centralized storage of digoxin antibodies are recommended to ensure prompt treatment availability.
• Consideration for rapid transport to an extracorporeal membrane oxygenation (ECMO) center should be part of severe digoxin toxicity management protocols.