This protocol addresses a specific subset of digoxin toxicity: patients who have no life-threatening manifestations but present with very high serum digoxin levels, or with elevated serum digoxin accompanied by troublesome clinical features.
The protocol applies to patients with digoxin toxicity who have very high serum digoxin (>12 nanograms/ml), or those with elevated serum digoxin associated with troublesome toxicity — moderate to severe gastrointestinal symptoms, or bradycardia without high-degree atrioventricular block. Serum digoxin measurement guides patient selection in both groups, including asymptomatic patients with markedly elevated levels.
Following serum digoxin assessment, the protocol involves a specific antidotal therapy — digoxin immune Fab — administered at a calculated partial dose. The full algorithm, including how the dose is determined and what additional measures may be considered in the acute setting, is available in the complete protocol.
Dosing methodology, sequencing, and monitoring parameters are in the full protocol below.
Close monitoring continues after treatment until normalisation of serum potassium, body temperature, blood pressure, ECG, and renal function. Potassium is assessed with particular frequency in the early post-treatment period.