History and exam
Key diagnostic factors
common
presence of risk factors
Risk factors include age >55 years, decreased renal clearance, hyperkalaemia, hypokalaemia, and use of specific drugs (e.g., amiodarone, clarithromycin, ciclosporin, itraconazole, propafenone, spironolactone, verapamil, diltiazem, ketoconazole, vinblastine, doxorubicin, reserpine, and erythromycin).
digoxin exposure
Confirm history of exposure to digoxin if possible.
gastrointestinal symptoms
Typically include nausea, vomiting, diarrhoea, abdominal pain, or anorexia.
central nervous system symptoms
Typically include lethargy, weakness, and confusion.
uncommon
visual symptoms
Rare. Typically include disturbances of colour vision with a tendency to perceive yellow halos around objects (xanthopsia), blurred vision, and diplopia. Xanthopsia is not as common in digoxin overdose as it is in digitoxin overdose.
Other diagnostic factors
common
suicidality
Patients or family members may provide the history of exposure or suicidality in acute digoxin toxicity.
cardiovascular symptoms
Typically include palpitations, syncope, arrhythmias, and dyspnoea.
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