Circulation

Commence continuous ECG monitoring and assess serial 12-lead ECGs in all patients with acute digoxin poisoning. Most patients develop some evidence of digoxin toxicity on a 12-lead ECG (see Clinical presentation). Patients may also have hyperkalaemic changes on a 12-lead ECG.

Digoxin-specific immune antibody fragments (Digoxin immune Fab) are the first-line treatment for a potentially lethal ingestion. While waiting to obtain digoxin immune Fab, atropine can be used to treat bradycardia associated with hypotension. Use:

Also consider temporary cardiac pacing if administration of digoxin immune Fab is delayed.