Guideline sources The following summarized guidelines for the management of digoxin toxicity are prepared by our editorial team based on guidelines from the American Heart Association (AHA 2020), the American Heart Association (AHA/HRS/ACC 2019), and the Extracorporeal Treatments in Poisoning Workgroup (EXTRIP 2016). 1 2 3 Guidelines 1. Medical management Digoxin immune Fab: As per AHA 2020 guidelines, administer antidigoxin Fab antibodies in patients with severe cardiac glycoside toxicity. B As per ACC 2019 guidelines, consider administering digoxin immune Fab to increase HR and improve symptoms in patients with bradycardia associated with symptoms or hemodynamic compromise in the setting of digoxin toxicity. C 2. Therapeutic procedures Extracorporeal treatment: As per ACC 2019 guidelines, do not offer hemodialysis for removal of digoxin in patients with bradycardia associated with symptoms or hemodynamic compromise attributable to digoxin toxicity. D As per EXTRIP 2016 guidelines, do not offer ECTR in any of the following situations: severe digoxin toxicity regardless if Fab is administered https://web.pathway.md/diseases/recGR7F51ejTFagGg 1/2 6/29/23, 10:17 PM Digoxin toxicity Pathway severe digoxin toxicity regardless if Fab is administered suspected digoxin ingestion regardless if Fab is administered elevated digoxin serum concentrations regardless if Fab is administered cardiovascular disturbances if Fab is administered serum potassium > 46.0 mmol/L. D Show 5 more Clinical findings Patient demographics Symptoms Elderly age Abdominal pain Dizziness Vital signs Loss of appetite Nausea Bradycardia Palpitations Tachycardia Shortness of breath Lab findings Visual disturbances Vomiting Hyperkalemia Neurological exam Altered mental status ECG findings AV block Atrial flutter Junctional escape rhythm Multifocal AT St-segment elevation References 1. Fred M Kusumoto, Mark H Schoenfeld, Coletta Barrett et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2019 Aug 20;140 8):e382-e482. Open 2. Ashish R Panchal, Jason A Bartos, Jos G Caba as et al. Part 3 Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142 16_suppl_2 S366 S468. Open 3. James B Mowry, Emmanuel A Burdmann, Kurt Anseeuw et al. Extracorporeal treatment for digoxin poisoning: systematic review and recommendations from the EXTRIP Workgroup. Clin Toxicol Phila). 2016;54 2 103 14. Open https://web.pathway.md/diseases/recGR7F51ejTFagGg 2/2