Digoxin arrhythmias

Adverse reactions to digoxin include anorexia, vomiting, diarrhea, dizziness, headaches, visual disturbances, and cardiac arrhythmias. Allergic reaction such as urticaria, skin emptions, fever, and edema have been reported (87). 

Adenosine and digoxin are agents used for the management of arrhythmias that do not fit into the Vaughan Williams classification. aSlows conduction, prolongs refractory period, and reduces automaticity in SA node and AV node tissue, but not in the ventricles. 

Digoxin Nausea, vomiting, anorexia, green-yellow halos around objects, ventricular arrhythmias... 

Maintenance dose 0.125-0.25 mg PO/IV qd low potassium or magnesium levels potentiate toxicity reduce dose in renal failure toxicity indicated by nausea, headache, visual disturbances (yellow-green halos), ventricular arrhythmias. Quinidine, verapamil, and amiodarone elevate digoxin level. 

Hypercalcemia from any cause predisposes the patient to digitalis toxicity. Calcium, particularly when administered rapidly by the IV route, may produce serious arrhythmias in digitalized patients. On the other hand, hypocalcemia can nullify the effects of digoxin in humans thus, digoxin may be ineffective until serum calcium is restored to normal. 

Electrical cardioversion It may be desirable to reduce the dose of digoxin for 1 to 2 days prior to electrical cardioversion of atrial fibrillation to avoid the induction of ventricular arrhythmias, but physicians must consider the consequences of increasing the ventricular response if digoxin is withdrawn. If digitalis toxicity is suspected, delay elective cardioversion. If it is not prudent to delay cardioversion, select the lowest possible energy level to avoid provoking ventricular arrhythmias. Lab test abnormalities Periodically assess serum electrolytes and renal function (serum creatinine concentrations) the frequency of assessments will depend on the clinical setting. 

The treatment of an overdosage of digoxin requires monitoring of cardiac rhythm in order to detect arrhythmias. 

Signs and symptoms of an arrhythmia (such as palpitations), or heart failure (such as dyspnea and edema) if f he digoxin level falls below the therapeutic level... 

Be especially alert for signs of potassium depletion, such as cardiac arrhythmias, in patients taking digoxin... 

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