A patient on digoxin therapy accidently consum ed 8 tablets of digoxin 0.25
mg. Two hours later, he presented to the emergency doctor with a heart rate of 54 bpm
and ECG evidence of third-degree AV block. What is the immediate management of this
patient?
A. Digoxin immune Fab
B. Lignocaine
C. Phenytoin
D. DC cardioversion
Answer. A
Solution. The immediate management of a patient who has taken an overdose of digoxin and
presents with a low heart rate (bradycardia) and evidence of third-degree AV block on ECG
would typically include administration of Digoxin Immune Fab (also known as Digibind or
Digifab). Digoxin Immune Fab is a specific antidote for digoxin toxicity that works by binding to
the drug in the bloodstream and removing it from the body. In this scenario, it is important to act
quickly to remove the excess digoxin from the patient’s bloodstream and to stabilize their heart
rate and rhythm. In addition to administering Digoxin Immune Fab, other treatments that may be
used to manage digoxin toxicity include electrolyte replacement (such as potassium
supplementation), supportive measures to maintain blood pressure, and correction of any
underlying electrolyte imbalances.
Lignocaine, Phenytoin, and DC cardioversion are not specific treatments for digoxin toxicity and
are not typically used as the first-line management in this scenario.