Acute and chronic digitalis toxicity: presentation and treatment

Although digitalis toxicity is commonly encountered, it can easily be mistaken because of its many manifestations. Recognition of toxicity depends on an awareness of the difference between an acute digitalis overdose and chronic digitalis toxicity. The gastrointestinal, central nervous, and cardiac conduction systems are most commonly involved. Ventricular ectopy and arrhythmias are common with chronic toxicity, while disturbances of sinus impulse formation, A-V blocks, and nodal arrhythmias are seen with both acute and chronic digitalis toxicity. Treatment is mainly supportive, except in acute poisoning, in which case attempts must be made to clear as much drug as possible from the gastrointestinal tract.