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First-line treatment for serious toxicity

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Consult expert advice.

The indications for a more energetic approach to digoxin toxicity include:

  • persistent nausea with vomiting
  • heart block
  • heart failure
  • cardiac arrhythmia

The management includes:

  • intravenous potassium:
    • 40 mmol potassium in 5% dextrose over 1 hr
    • ECG monitoring throughout
    • potassium is stopped if sinus rhythm returns or there are signs of hyperkalaemia e.g. peaked T waves
    • a total of 120 mmol may be given
    • if initial potassium levels were normal, then the risk of hyperkalaemia is reduced if the potassium is infused in 250 ml of 20% dextrose with 30 U of soluble insulin

  • intravenous magnesium:
    • magnesium protect the myocardium
    • give 50 ml of 2% magnesium sulphate over 1 hr
    • repeat infusion as required

  • activated charcoal p.o.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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