Which of the following does not contribute to Digoxin toxicity:
Ans:A.)Hyperkalemia Digoxin toxicity Symptoms include vomiting, loss of appetite, confusion, blurred vision, changes in color perception, and decreased energy. Potential complications include an irregular heabeat, which can be either too fast or too slow. Toxicity may occur over a sho period of time following an overdose or gradually during long-term treatment. Risk factors include low potassium, low magnesium, and high calcium. The most common precipitating cause of digitalis intoxication is depletion of potassium stores, which occurs often in patients with hea failure as a result of diuretic therapy and secondary hyperaldosteronism. Digoxin toxicity increases in individuals who have kidney impairment Diagnosis Serum digoxin level Therapeutic levels are 0.6-1.3 to 2.6 ng/mL. Electrolytes In acute toxicity, hyperkalemia is common Chronic toxicity is often accompanied by hypokalemia and hypomagnesemia Electrocardiography Digoxin toxicity may cause almost any dysrhythmia Classically, dysrhythmias associated with increased automaticity and decreased AV conduction occur Sinus bradycardia and AV conduction blocks are the most common ECG changes in the pediatric population, while ventricular ectopy is more common in adults Nonparoxysmal atrial tachycardia with hea block and bidirectional ventricular tachycardia are paicularly characteristic of severe digitalis toxicity Management Suppoive care of digitalis toxicity includes the following: Hydration with IV fluids Oxygenation and suppo of ventilatory function Discontinuation of the drug, and, sometimes, the correction of electrolyte imbalances GI decontamination Activated charcoal is indicated for acute overdose or accidental ingestion Binding resins (eg, cholestyramine) may bind enterohepatically-recycled digoxin Treatment of electrolyte imbalance For hyperkalemia, use insulin plus glucose, and sodium bicarbonate if the patient is acidotic Treatment with digoxin Fab fragments is indicated for a K + level greater than 5 mEq/L Hemodialysis may be necessary for uncontrolled hyperkalemia Correct hypokalemia (usually in chronic intoxication) Concomitant hypomagnesemia may result in refractory hypokalemia
Hyperkalemia
Hypercalcemia
Renal failure
Hypomagnesemia