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Digoxin Toxicity in a Patient with Pacemaker: A Case Report.

Rachel E Bridwell1, Keith A Baker2, Christopher O Hoyte3

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Digoxin-specific antibody fragments are used for toxicity, but indications are inconsistent. A case study and chart review suggest careful consideration is needed for high digoxin levels, even in pacemaker patients.

Keywords:
digoxindigoxin specific antibodymedication error

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Area of Science:

  • Pharmacology
  • Cardiology
  • Toxicology

Background:

  • Digoxin, a cardiac glycoside, inhibits the sodium/potassium ATPase pump, treating heart failure and atrial fibrillation.
  • Digoxin has a narrow therapeutic index, necessitating careful monitoring to avoid toxicity.
  • Digoxin-specific antibody fragments are the current antidote for severe digoxin toxicity.

Observation:

  • A case of asymptomatic elevated digoxin level (13.5 ng/mL) due to a dosing error was managed without antibody fragments.
  • A retrospective chart review examined patients with pacemakers and high digoxin concentrations, comparing outcomes with and without antibody fragment administration.

Findings:

  • The asymptomatic patient with an elevated digoxin level was successfully managed conservatively.
  • Outcomes in pacemaker patients with high digoxin levels treated with or without antibody fragments were equivocal, suggesting no clear benefit in all cases.

Implications:

  • The findings challenge the consistent use of digoxin-specific antibody fragments solely based on serum concentration thresholds.
  • Further research is needed to refine indications for digoxin-specific antibody fragments, especially in patients with pacemakers.
  • Clinical judgment and patient-specific factors should guide treatment decisions for elevated digoxin levels.