120. What is the treatment for digoxin toxicity and when should Digibind (Fab) be given?

Digoxin administration should be discontinued immediately. Arrhythmia should be treated according to ACLS (Advanced Cardiac Life Support) protocols. Intravenous fluids given for hypotension. If hemodynamic compromise is present or serious arrhythmia manifests from digoxin toxicity, then the mainstay of treatment is digoxin specific antibody (Fab). Below are the indications to give Fab:

1. Life threatening arrhythmia including ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation), asystole, complete or high grade AV block or other symptomatic bradycardia.

2. Evidence of end-organ dysfunction (renal failure, shock liver, altered mental status).

3. Significant hyperkalemia (serum potassium > 5.5 mmol/L).