Digoxin Toxicity
Clinical Assessment Tool

Start

Select suspected clinical condition of the patient.

ACUTE

Digoxin Toxicity

CHRONIC

Digoxin Toxicity

Has there been a known ingestion of digoxin (suicidal or accidental) of ≥10 mg in a healthy adult or >4 mg in a healthy child?*

*Suicidal ingestion may involve more than one drug. Toxic effects of other drugs or poisons should not be overlooked.

Is there clinical suspicion for digoxin toxicity?

Select all that apply.

Current or recent digoxin use and at least one of the following:

History of concomitant medication that interacts with digoxin
(e.g., quinidine, verapamil, diltiazem, carvedilol, amiodarone, spironolactone)
History of renal insufficiency
History of hypokalemia or other electrolyte abnormalities
History of other comorbid disease that might cause clinical toxicity at lower digoxin levels

Other clinical suspicion for digoxin toxicity

Review the patient’s history, treat their symptoms, and explore other causes.

Are there signs or symptoms of potentially
life-threatening digoxin toxicity?

Are there signs or symptoms of potentially life-threatening digoxin toxicity?

Select all that apply.

Cardiac dysrhythmias

Severe ventricular dysrhythmias
(e.g., ventricular tachycardia, ventricular fibrillation)
Progressive bradydysrhythmias
(e.g., severe sinus bradycardia, second- or third-degree heart block unresponsive to atropine)
None of the above

Are there signs or symptoms of potentially life-threatening digoxin toxicity?

Select all that apply.

Laboratory parameters

Severely elevated serum potassium concentrations with rapidly progressive signs and symptoms (e.g., >5.5 mEq/L in adults or >6 mEq/L in children)
Severely elevated serum digoxin concentrations with clinically significant signs and symptoms (e.g., steady-state concentrations >6 ng/mL in adults or >4 ng/mL in children)*
None of the above

Samples should be collected at least 6-8 hours after the last dose of digoxin to allow for equilibration between serum and tissue.

Are there signs or symptoms of potentially
life-threatening digoxin toxicity?

Are there signs or symptoms of potentially life-threatening digoxin toxicity?

Select all that apply.

Evidence of end-organ dysfunction from hypoperfusion

Renal (e.g., elevated BUN, elevated creatinine)
Neurologic (e.g., lethargy, confusion, disorientation, weakness, visual changes)
GI (e.g., abdominal pain, nausea, vomiting, diarrhea)
Other evidence of end-organ dysfunction
None of the above

If no signs or symptoms of digoxin toxicity are observed…

Monitor the patient, repeat laboratory tests, and perform serial examinations.

Any sign or symptom of potentially life-threatening

digoxin toxicity may indicate the need for immediate intervention with DIGIFab.

Any sign or symptom of potentially life-threatening digoxin toxicity may indicate the need for immediate intervention with DIGIFab.

To determine dosing for patients with acute digoxin toxicity, identify if the amount of ingested digoxin is known or unknown.

Any sign or symptom of potentially life-threatening

digoxin toxicity may indicate the need for immediate intervention with DIGIFab.

Any sign or symptom of potentially life-threatening digoxin toxicity may indicate the need for immediate intervention with DIGIFab.

To determine dosing for patients with chronic digoxin toxicity, identify if a steady-state serum digoxin concentration is known or unknown.

For patients with acute digoxin toxicity and a known amount of ingested digoxin, the dose of DIGIFab can be calculated based on total digoxin body load.

Total digoxin body load* (mg)

x

0.8 0.5 mg

*Total body load for digoxin tablets is approximately equal to the amount ingested (in mg) x 0.8 (bioavailability of the tablet preparation).

Access Dose Calculator

Dosing for patients with acute digoxin toxicity and an unknown amount of ingested digoxin:

Monitor for volume overload in small (<20 kg) children
Initiate with 10 vials followed by an additional 10 vials, if needed, to avoid a febrile reaction

For patients with chronic digoxin toxicity and a known steady-state
serum digoxin concentration, the dose of DIGIFab can be calculated based on serum digoxin concentration* and patient weight.

Serum digoxin (ng/mL)

x

weight (kg)

100

*Samples should be collected at least 6-8 hours after the last dose of digoxin to allow for equilibration between serum and tissue.

Access Dose Calculator

Dosing for patients with chronic digoxin toxicity and an unknown steady-state serum digoxin concentration:

Results

The patient characteristics you selected are consistent with potentially life-threatening digoxin toxicity. Early recognition of digoxin toxicity is essential and may result in improved treatment outcomes.

For potentially life-threatening digoxin toxicity, think R.A.P.I.D.

Recognize. Act. Promptly Infuse DIGIFab.

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BTG and the BTG roundel logo are registered trademarks of BTG International Ltd. DIGIFab is a registered trademark of BTG International Inc. 2021 BTG International Inc. All rights reserved. US-DGF-2100056 October 2021

Digoxin Toxicity Clinical Assessment Tool

Select suspected clinical condition of the patient.

ACUTE

Digoxin Toxicity

CHRONIC

Digoxin Toxicity

Has there been a known ingestion of digoxin (suicidal or accidental) of ≥10 mg in a healthy adult or >4 mg in a healthy child?*

Is there clinical suspicion for digoxin toxicity?

Select all that apply.

Current or recent digoxin use and at least one of the following:

Other clinical suspicion for digoxin toxicity

If digoxin toxicity is not suspected…

Review the patient’s history, treat their symptoms, and explore other causes.

Are there signs or symptoms of potentially life-threatening digoxin toxicity?

Are there signs or symptoms of potentially life-threatening digoxin toxicity?

Select all that apply.

Cardiac dysrhythmias

Are there signs or symptoms of potentially life-threatening digoxin toxicity?

Are there signs or symptoms of potentially life-threatening digoxin toxicity?

Select all that apply.

Laboratory parameters

Are there signs or symptoms of potentially life-threatening digoxin toxicity?

Are there signs or symptoms of potentially life-threatening digoxin toxicity?

Select all that apply.

Evidence of end-organ dysfunction from hypoperfusion

If no signs or symptoms of digoxin toxicity are observed…

Monitor the patient, repeat laboratory tests, and perform serial examinations.

Any sign or symptom of potentially life-threatening

digoxin toxicity may indicate the need for immediate intervention with DIGIFab.

Any sign or symptom of potentially life-threatening digoxin toxicity may indicate the need for immediate intervention with DIGIFab.

To determine dosing for patients with acute digoxin toxicity, identify if the amount of ingested digoxin is known or unknown.

Any sign or symptom of potentially life-threatening

digoxin toxicity may indicate the need for immediate intervention with DIGIFab.

Any sign or symptom of potentially life-threatening digoxin toxicity may indicate the need for immediate intervention with DIGIFab.

To determine dosing for patients with chronic digoxin toxicity, identify if a steady-state serum digoxin concentration is known or unknown.

For patients with acute digoxin toxicity and a known amount of ingested digoxin, the dose of DIGIFab can be calculated based on total digoxin body load.

Total digoxin body load* (mg)

x

0.8

0.5 mg

Dosing for patients with acute digoxin toxicity and an unknown amount of ingested digoxin:

For patients with chronic digoxin toxicity and a known steady-state serum digoxin concentration, the dose of DIGIFab can be calculated based on serum digoxin concentration* and patient weight.

Serum digoxin (ng/mL)

x

weight (kg)

100

Dosing for patients with chronic digoxin toxicity and an unknown steady-state serum digoxin concentration:

Results

The patient characteristics you selected are consistent with potentially life-threatening digoxin toxicity. Early recognition of digoxin toxicity is essential and may result in improved treatment outcomes.

For potentially life-threatening digoxin toxicity, think R.A.P.I.D.

Recognize. Act. Promptly Infuse DIGIFab.

Digoxin Toxicity
Clinical Assessment Tool

Are there signs or symptoms of potentially
life-threatening digoxin toxicity?

Are there signs or symptoms of potentially
life-threatening digoxin toxicity?

Are there signs or symptoms of potentially
life-threatening digoxin toxicity?

For patients with chronic digoxin toxicity and a known steady-state
serum digoxin concentration, the dose of DIGIFab can be calculated based on serum digoxin concentration* and patient weight.