Dig Toxicity

[NurseyPoo7]

Had a new admit today with this. We're a med surg floor with tele --- we normally dont get cardiac pts (at least those with active, new issues), we're just medical tele. I've never cared for a person with dig toxicity, so all I know is what I've learned in school regarding signs and symptoms. The pt seemed stable to me although the condition was marked as "serious" by the MD. His tele looked OK and his labs were alright, no hypokalemia or anything. His dig level was 3.6.

I know they will stop/hold the dig until this clears up but what other kind of treatments can I expect? Is there anything I need to watch out for that a more experienced nurse might pick up (I've only been in the acute care setting for about 5 months now)?

Thanks

[leslie :-D]

usually i've seen dig toxicity present as n/v, diarrhea and ms changes:

as well as hyperkalemia and arrhythmias.

bradys, av blocks have been tx'd w/atropine.

vtach s/b tx'd with phenytoin (doc).

resistant vtach or any hemodynamic instability is tx'd w/dig-binding abs, e.g., digibind.

but your pt 'sounds' stable and likely needs to have lytes, dig levels monitored.

leslie

[NurseyPoo7]

After the dig tox clears, will the MD place the pt back on dig - same dosage as before or a lower dosage?

[grammyr]

My first question after making sure the patient is stable is "How did he/she become toxic?" Talk to the patient and/or family about his ability to take the medication properly and the importance of doing this. Is it someone who may forget to take one for a couple of days and then take enough to "catch up"? Wasn't there a recall on the digitek for being too potent in some of the pills? If so, then maybe this patient didn't know or didn't want to take the meds back to the pharmacy and happened to get the double dose.

If this patient qualifies for home health, maybe he needs help setting up his meds and education on taking them correctly. Home health can prefill his meds and monitor for compliance.

[Daytonite, BSN, RN]

Good information on the Internet:

• http://www.emedicine.com/EMERG/topic137.htm - Digitalis Toxicity
  
• http://www.fpnotebook.com/CV/Pharm/DgxnTxcty.htm - Digixin Toxicity