Digoxin poisoning

At a glance

• Chronic toxicity in an older patient on long-term digoxin is far more common than acute overdose, and it presents with vague nausea, confusion and bradycardia rather than collapse.
• Toxicity is a clinical diagnosis supported by a level. The level has to be read against timing, potassium and renal function.
• Potassium points two ways: high potassium in acute overdose signals severe poisoning, while low potassium in chronic therapy makes toxicity occur at lower levels.