Digoxin toxicity with therapeutic serum digoxin concentrations
Introduction: Digoxin is a cardiac glycoside used for rate control in atrial fibrillation and heart failure. Despite its efficacy, digoxin has a narrow therapeutic window and can cause severe side effects, including life-threatening arrhythmias. Literature and guidelines on management of digoxin tox...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-12-01
|
| Series: | Toxicology Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214750025001970 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849320875358158848 |
|---|---|
| author | J. Graafsma N. Cimic M. Dijkman F.M.J. Gresnigt D. Mitrovic C. Smit |
| author_facet | J. Graafsma N. Cimic M. Dijkman F.M.J. Gresnigt D. Mitrovic C. Smit |
| author_sort | J. Graafsma |
| collection | DOAJ |
| description | Introduction: Digoxin is a cardiac glycoside used for rate control in atrial fibrillation and heart failure. Despite its efficacy, digoxin has a narrow therapeutic window and can cause severe side effects, including life-threatening arrhythmias. Literature and guidelines on management of digoxin toxicity remain inconsistent whether to include serum digoxin concentrations as a key criterium for diagnosing digoxin toxicity and determining the indication for digoxin-specific antibody fragments. This report presents a case of digoxin toxicity at therapeutic serum concentrations. Case report: A 76-year-old male presented with bradycardia, hyperkalemia, and acute kidney injury following gastrointestinal bleeding. Despite serum digoxin concentrations within the therapeutic range (1.4 ng/ml), the patient exhibited symptoms consistent with severe digoxin toxicity. Initial treatments, including calcium gluconate, insulin-glucose, and sodium bicarbonate, failed to resolve hyperkalemia and/or bradycardia. Administration of 40 mg digoxin-specific antibody fragments led to rapid normalization of potassium levels, improved heart rate, and hemodynamic stabilization, indicative for severe digoxin toxicity despite therapeutic serum concentrations. Discussion: This case demonstrates that digoxin toxicity can occur at serum concentrations in therapeutic range, emphasizing the importance of clinical features in diagnosing digoxin toxicity. Current guidelines vary on the role of serum digoxin concentrations in guiding the use of digoxin-specific antibody fragments, but this case underscores its efficacy in resolving symptoms related to digoxin toxicity, even at low serum concentrations. |
| format | Article |
| id | doaj-art-a995e5945bf945178ff5f17262bca490 |
| institution | Kabale University |
| issn | 2214-7500 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Toxicology Reports |
| spelling | doaj-art-a995e5945bf945178ff5f17262bca4902025-08-20T03:49:55ZengElsevierToxicology Reports2214-75002025-12-011510207910.1016/j.toxrep.2025.102079Digoxin toxicity with therapeutic serum digoxin concentrationsJ. Graafsma0N. Cimic1M. Dijkman2F.M.J. Gresnigt3D. Mitrovic4C. Smit5Department of Hospital Pharmacy, Frisius MC, Heerenveen, the Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the NetherlandsDepartment of Intensive Care Medicine, Frisius MC, Heerenveen, the NetherlandsDutch Poisons Information Center, UMC Utrecht, Utrecht, the NetherlandsDutch Poisons Information Center, UMC Utrecht, Utrecht, the Netherlands; Department of Emergency Medicine, OLVG, Amsterdam, the Netherlands; Correspondence to: Oosterpark 9, Amsterdam 1091AC, the Netherlands.Department of Hospital Pharmacy, Frisius MC, Heerenveen, the NetherlandsDepartment of Clinical Pharmacy, Antonius hospital, Sneek, the NetherlandsIntroduction: Digoxin is a cardiac glycoside used for rate control in atrial fibrillation and heart failure. Despite its efficacy, digoxin has a narrow therapeutic window and can cause severe side effects, including life-threatening arrhythmias. Literature and guidelines on management of digoxin toxicity remain inconsistent whether to include serum digoxin concentrations as a key criterium for diagnosing digoxin toxicity and determining the indication for digoxin-specific antibody fragments. This report presents a case of digoxin toxicity at therapeutic serum concentrations. Case report: A 76-year-old male presented with bradycardia, hyperkalemia, and acute kidney injury following gastrointestinal bleeding. Despite serum digoxin concentrations within the therapeutic range (1.4 ng/ml), the patient exhibited symptoms consistent with severe digoxin toxicity. Initial treatments, including calcium gluconate, insulin-glucose, and sodium bicarbonate, failed to resolve hyperkalemia and/or bradycardia. Administration of 40 mg digoxin-specific antibody fragments led to rapid normalization of potassium levels, improved heart rate, and hemodynamic stabilization, indicative for severe digoxin toxicity despite therapeutic serum concentrations. Discussion: This case demonstrates that digoxin toxicity can occur at serum concentrations in therapeutic range, emphasizing the importance of clinical features in diagnosing digoxin toxicity. Current guidelines vary on the role of serum digoxin concentrations in guiding the use of digoxin-specific antibody fragments, but this case underscores its efficacy in resolving symptoms related to digoxin toxicity, even at low serum concentrations.http://www.sciencedirect.com/science/article/pii/S2214750025001970Digoxin toxicityDigoxin antibodiesRenal failureHyperkalemia |
| spellingShingle | J. Graafsma N. Cimic M. Dijkman F.M.J. Gresnigt D. Mitrovic C. Smit Digoxin toxicity with therapeutic serum digoxin concentrations Toxicology Reports Digoxin toxicity Digoxin antibodies Renal failure Hyperkalemia |
| title | Digoxin toxicity with therapeutic serum digoxin concentrations |
| title_full | Digoxin toxicity with therapeutic serum digoxin concentrations |
| title_fullStr | Digoxin toxicity with therapeutic serum digoxin concentrations |
| title_full_unstemmed | Digoxin toxicity with therapeutic serum digoxin concentrations |
| title_short | Digoxin toxicity with therapeutic serum digoxin concentrations |
| title_sort | digoxin toxicity with therapeutic serum digoxin concentrations |
| topic | Digoxin toxicity Digoxin antibodies Renal failure Hyperkalemia |
| url | http://www.sciencedirect.com/science/article/pii/S2214750025001970 |
| work_keys_str_mv | AT jgraafsma digoxintoxicitywiththerapeuticserumdigoxinconcentrations AT ncimic digoxintoxicitywiththerapeuticserumdigoxinconcentrations AT mdijkman digoxintoxicitywiththerapeuticserumdigoxinconcentrations AT fmjgresnigt digoxintoxicitywiththerapeuticserumdigoxinconcentrations AT dmitrovic digoxintoxicitywiththerapeuticserumdigoxinconcentrations AT csmit digoxintoxicitywiththerapeuticserumdigoxinconcentrations |