Question

A patient was brought to the emergency with a history of consumption of 8 tablets of digoxin. On examination he was unstable and his heart rate was 56 bpm. ECG showed a 3rd-degree heart block. What is the next step in the management of this patient?

• A. Antibody against digoxin
• B. Lidocaine
• C. DC cardioversion
• D. Phenytoin

Answer 1

The Correct Option is A

The patient in this scenario has overdosed on digoxin, presenting with bradycardia (heart rate of 56 bpm) and a 3rd-degree heart block as shown on ECG. Digoxin overdose can lead to severe cardiac disturbances, including heart block and arrhythmias. The appropriate management of severe digoxin toxicity, particularly when there is evidence of life-threatening cardiac arrhythmias or significant bradycardia, involves the use of digoxin-specific antibody fragments.

Step-by-step management:

• Identify the presence of symptoms suggestive of severe digoxin toxicity, such as bradycardia and arrhythmias.
• Recognize that a 3rd-degree heart block on ECG is a serious condition that can result from digoxin overdose.
• The most direct and effective treatment for digoxin toxicity causing life-threatening symptoms is the administration of digoxin-specific antibodies, known as Digibind or DigiFab.
• These antibody fragments bind to the digoxin, forming a compound that is then excreted from the body, thereby reversing the toxic effects.

Other options like lidocaine, DC cardioversion, or phenytoin are not suitable as initial treatments in this context:

• Lidocaine is typically reserved for specific ventricular arrhythmias, not appropriate here solely for bradycardia or heart block due to digoxin.
• DC cardioversion is not indicated for bradycardia or heart block and can exacerbate digoxin toxicity arrhythmias.
• Phenytoin can sometimes be used for digitalis-induced ventricular tachycardia but is not the first-line treatment for heart block.

Therefore, the most appropriate and effective management in this case is the antibody against digoxin.