Chronic Digoxin Toxicity: An Evaluation of Digoxin-Specific Antibodies and Other Management Options

Abstract

Chronic digoxin toxicity comprises the bulk of digoxin poisonings and can be more difficult to manage than acute intoxications. A 60-year-old lady presented with severe chronic digoxin toxicity after ingesting digoxin 250mcg twice a day (BD) for two weeks. Due to hemodynamic instability on presentation, she was treated with digoxin-specific antibodies and admitted to the coronary care unit. This case of chronic digoxin toxicity did not respond to digoxin-specific antibodies and required intensive cardiac therapy with isoprenaline and intravenous electrolyte replacement, highlighting the complexities in the management of toxicity. Our patient has since recovered and remains stable. There are newer, novel therapies being trialed for the treatment of digoxin toxicity, including dextrose-insulin infusions, therapeutic plasma exchange, and rifampicin, but these require more research and investigation in this cohort of patients.