Digoxin overdose

Serum digoxin concentration

Serum digoxin concentration is usually over the therapeutic range of 0.5 to 0.9 nanograms/mL in patients taking digoxin for heart failure. However, some patients can be toxic at therapeutic digoxin serum concentrations.

Severity

Significant overdose, requiring treatment with digoxin-specific antibody fragments intravenously, is characterized by:

• Symptomatic bradyarrhythmias

• Ventricular dysrhythmias

• Any patient with acute digoxin overdose and potassium concentrations >5.0 mEq/L

• Acute ingestion of >4 mg in a healthy child (or 0.1 mg/kg)

• Acute ingestion of >10 mg in a healthy adult

• Serum concentration of ≥10 nanograms/mL 4 to 6 hours after ingestion (steady state)

• Serum concentration of ≥15 nanograms/mL at any time