This protocol covers adult patients who have ingested a bolus dose of digoxin — intentionally or inadvertently — with no antecedent chronic background use, and whose presentation is not life-threatening.
The patient has sustained an acute exposure, distinct from chronic toxicity: a discrete bolus ingestion with no prior therapeutic digoxin background. Gastrointestinal decontamination with activated charcoal has a recognised role in this acute-ingestion setting, where it can shorten the elimination half-life of digoxin.
Management may involve Digoxin immune Fab, an antibody-based antidote, when specific laboratory thresholds are met. The precise eligibility criteria, decision thresholds, and full regimen are available in the complete protocol below.
DOI: 10.1016/j.amjmed.2024.08.018
Acute: bolus (intentional or inadvertent) without antecedent background use
Our findings support use of activated charcoal in acute ingestion to shorten the elimination half-life of digoxin.
in the absence of other clinical findings, treatment when the serum digoxin concentration is >4 ng/mL in patients with acute or chronic digoxin ingestion;
in adult patients with acute or chronic digoxin ingestion and suspected digoxin toxicity with no other reason for hyperkalemia, when the serum potassium concentration is ≥6 mEq/L;
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