Cardiovascular · Year 1 · from Cardiovascular
Case 1: Digoxin Toxicity - Na+/K+-ATPase Inhibition
Clinical Image
Source: Wikimedia Commons - Digoxin effect ECG - CC BY-SA 3.0
Patient Presentation
A 78-year-old woman is brought to the emergency department by her family after 2 days of nausea, vomiting, confusion, and visual disturbances. She describes seeing yellow-green halos around lights and everything looks "yellowish." She has atrial fibrillation and heart failure and was recently started on a new medication for a urinary tract infection.
Demographics
- Age: 78 years
- Sex: Female
- Past Medical History: Atrial fibrillation, HFrEF (EF 35%), CKD stage 3 (baseline Cr 1.6)
- Medications: Digoxin 0.125 mg daily, lisinopril, carvedilol, furosemide, and newly started clarithromycin for UTI
Chief Complaint
Nausea, vomiting, confusion, and yellow-tinged vision
Physical Examination
- Blood pressure: 102/64 mmHg
- Heart rate: 42 bpm (markedly bradycardic)
- Temperature: 36.8°C
- General: Confused, appears ill
- Cardiovascular: Bradycardic, irregularly irregular rhythm with long pauses
- Neurological: Disoriented to time and place, no focal deficits
- Pupils: Normal
Workup
- Serum digoxin level: 3.6 ng/mL (toxic; therapeutic 0.8-2.0 ng/mL)
- Serum potassium: 5.8 mEq/L (elevated)
- Serum creatinine: 2.4 mg/dL (worsened from baseline 1.6)
- ECG: Atrial fibrillation with complete heart block and slow junctional escape rhythm (40 bpm), frequent PVCs with coupling, "scooped" ST segments (digoxin effect)
- Additional findings: Bidirectional ventricular tachycardia noted transiently
Diagnosis
Severe Digoxin Toxicity precipitated by:
- Drug interaction with clarithromycin (P-glycoprotein inhibitor, increases digoxin levels)
- Acute kidney injury (decreased digoxin clearance)
Treatment
- Discontinue digoxin immediately
- Digoxin-specific antibody fragments (DigiFab) for:
- Life-threatening arrhythmias (complete heart block, ventricular arrhythmias)
- Potassium >5.5 mEq/L
- Cardiac monitoring in ICU
- Avoid calcium administration (can worsen digoxin toxicity)
- Treat hyperkalemia if severe (insulin/glucose, not calcium)
- Temporary pacing if symptomatic bradycardia persists
- Discontinue clarithromycin
- Review and adjust future digoxin dosing based on renal function
Physiological Principles Demonstrated
- Digoxin mechanism: Digoxin inhibits the Na+/K+-ATPase, increasing intracellular sodium. This reduces the gradient driving the Na+/Ca2+ exchanger, leading to increased intracellular calcium and enhanced contractility.
- Toxicity mechanism: Excessive inhibition causes calcium overload, leading to delayed afterdepolarizations and triggered arrhythmias. Hyperkalemia further inhibits the Na+/K+-ATPase, worsening toxicity.
- Drug interaction: Clarithromycin inhibits P-glycoprotein, which normally pumps digoxin out of cells and into the gut lumen. Inhibition increases digoxin absorption and tissue concentrations.
- Digibind mechanism: Fab fragments bind free digoxin, preventing it from binding to the Na+/K+-ATPase. The bound complex is renally excreted.