Digoxin toxicity

Acute: large single ingestion in non-toxic patient — early hyperkalaemia, hypotension, bradyarrhythmia. Chronic: established therapy + precipitant (renal impairment, hypokalaemia, hypomagnesaemia, hypercalcaemia, age, drug interactions: amiodarone, verapamil, diltiazem, macrolides, ciclosporin). Features: nausea, vomiting, abdominal pain, anorexia, confusion, visual changes (xanthopsia, halos), bradyarrhythmias, AV block, atrial tachycardia with block (hallmark), bidirectional VT. ABCDE; continuous ECG; bloods: digoxin level (>6 h post-dose for steady state), U&E (K⁺ critical), magnesium, calcium, creatinine, paracetamol/salicylate. ECG (look for AT with block, scooped ST, regularised AF, ventricular ectopy).