Digoxin

Daytonite, BSN, RN · Oct 30, 2009

Are you thinking that taking Digoxin and having flu like symptoms are somehow related? I don't think so. Just what are these symptoms?

kafluknik · Oct 30, 2009

Daytonite,

Thanks for replying. Looking at my question now I forgot to mention that pt is 86 yrs old. Anyways, my first thought was to give the digoxin because it lowers the HR, monitor the pt, hook up to ECG and then notify prescriber immediately.

I was told that the symptoms indicate "toxicity" and to withhold medication since digoxin has a narrow range between therapeutic vs toxic effects. I am still confused as to how 110bpm and flu-like symptoms go with toxicity. I am thinking it is just a safety issue considering that the pt has multiple illnesses.

Thanks for thinking with me :)

ellakate · Oct 30, 2009

I am still confused as to how 110bpm and flu-like symptoms go with toxicity. I am thinking it is just a safety issue considering that the pt has multiple illnesses.
Thanks for thinking with me :)

That is what I would think. A Safety Issue.

armytruck · Oct 30, 2009

In the real world, I'd send a Dig level, get an EKG and wait for the level. All of these symptoms could be present if pt's level as too low and had changed into an afib rhythm as well. You'll never be wrong if your first step is MORE assessment of the patient.

kafluknik · Oct 30, 2009

Thanks, everyone.

My 1st thought was I would have known that digoxin levels are okay since the chart would have current lab values.

@armytruck: yes, low levels would also send pt into afib - That's why I wanted to give the digoxin. (I'm just relieved that I was on the right track and that my understanding is correct)

But since this scenario doesn't give more details, I think that it does make sense to be on the safe side. And of course, MORE assessments as armytruck states was on my list of "to do".

Thank you all.

shrimpchips, LPN · Nov 3, 2009

the information presented in this scenario are a little vague, especially based on what type of "flu-like symptoms" the patient is having.

Think about the signs and symptoms of impending digoxin toxicity:

visual disturbances (halos, yellowish tints around objects, blurred vision), dizziness, anorexia, N&V, fatigue (those four could be "flu-like symptoms" although N&V are more common in children than adults). Signs of actual digoxin toxicity = dysrhythmias, which aren't indicated in the scenario.

I would have done the same thing that armytruck would have done.

kafluknik · Nov 4, 2009

thanks, shrimpchips!