For chronic outpatient therapy, 0.5-1 ng/mL (0.6-1.2 nM/L) is probably ideal.Interpretation of the digoxin level in digoxin intoxication For chronic intoxication, a single digoxin level is adequate, provided that it is obtained >6 hours after the last dose.For acute intoxication, check a baseline digoxin level and then repeat another level six hours after the ingestion.Only post-distribution levels reflect the severity of intoxication and help calculate the dose of antiserum. Digoxin requires >6 hours to distribute into the tissues, after oral intake.(2) Clinical constellation suggestive of cardiac glycoside intoxication.Any signs or symptoms suggestive of digoxin poisoning.Acutely ill enough to require hospital admission.(1) A patient who is chronically on digoxin, with any of the following:.It may obscure the presence of digitalis effect.It may prevent the occurrence of some arrhythmias (e.g., bradydysrhythmias).A pacemaker may impair the ability to diagnose digoxin toxicity:.So this may be helpful to identify patients with exposure to cardiac glycosides – but it is otherwise nonspecific (especially in a patient who is known to be on digoxin). Digitalis effect reveals the presence of digoxin, but doesn't correlate with clinical digoxin toxicity.Flattened/inverted T-wave, which may be followed by a prominent U-wave.Scooped ST segment with ST depression (“Salvador Dali mustache”).Digitalis effect refers to the following morphological pattern:.Paroxysmal atrial tachyarrhythmias with AV block.Visual disturbances (altered color perception, blurred vision, photophobia, diplopia, blindness).ġ) some uncommon arrhythmias may particularly suggest the possibility of digoxin toxicity. ![]()
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