Toxicology

iv.

BP, HR, and other available hemodynamic parameters should be recorded at least every 15

minutes during the infusion.

Adverse effects may include pancreatitis, jaundice, coagulopathies, interference with

laboratory results, and fat embolism.

vi.

Drug interactions are not well known.

Patient Case

Questions 7 and 8 pertain to the following case.

A 52-year-old man is admitted to the ED with concerns about dizziness and headache. His vital signs are as

follows: temperature 98.9°F (37.2°C), BP 87/50 mm Hg, and HR 58 beats/minute. His wife reports that he has a

history of hypertension and that he was recently given a diagnosis of being in the early stages of Alzheimer dis-

ease. She has brought his medications with her; the 1-month supply was refilled 2 days ago: a bottle of diltiazem

CD 120 mg/day (7 tablets remaining) and a bottle of donepezil 5 mg once daily (28 tablets remaining).

Which decontamination strategy would provide the most benefit?

Which antidote would be best to administer first?

The cardiac glycosides accounted for 1051 single-agent toxic exposures and 29 deaths in 2022.

suppression of the atrioventricular node.

Because of its narrow therapeutic index, toxicity has been reported in as many as 35% of patients

receiving digoxin (Postgrad Med 1993;69:337-9).

The normal therapeutic range is 0.8–2.1 ng/mL.

Toxicity may be related to an acute ingestion or may be an issue with chronic use in renal

dysfunction.

Risk factors for digoxin toxicity include renal failure, advanced age, ischemic heart disease, left

ventricular dysfunction, electrolyte imbalances (hypokalemia, hypomagnesemia, hypercalcemia), and

hypothyroidism (Postgrad Med 1993;69:337-9).