Your client is taking digoxin 0.250 mg PO daily. Which signs may indicate toxicity?

Your client is taking digoxin 0.250 mg PO daily. Which signs may indicate toxicity?

• A. Dry mouth, convulsion, and coma.
• B. Muscle cramps in the legs.
• C. Nausea, diarrhea, pulse below 60 beats per minute.
• D. Increased perspiration, feeling of stimulation, and a very fast pulse.

Answer: (C)

Digoxin toxicity most often shows up with gastrointestinal upset and slowed heart rate. The drug’s effect on the heart can slow AV nodal conduction, and when the level is high, the heart rate can drop (bradycardia) while the GI tract becomes irritated, producing nausea and diarrhea. The combination of nausea, diarrhea, and a pulse below 60 beats per minute fits this pattern and is a classic warning sign that digoxin toxicity may be developing. Other signs listed don’t align as clearly with digoxin toxicity. Dry mouth with convulsions or coma isn’t a typical early cluster of symptoms for digoxin; muscle cramps in the legs are nonspecific and not as indicative of digoxin effects, and symptoms like increased sweating with a very fast pulse point away from the common bradycardic toxicity pattern you’d expect with digoxin. If these signs appear, the prudent step is to assess the pulse, hold the dose if the heart rate is under 60, and notify the clinician for evaluation of digoxin levels and electrolytes, since factors like potassium level can influence toxicity risk.

Digoxin toxicity most often shows up with gastrointestinal upset and slowed heart rate. The drug’s effect on the heart can slow AV nodal conduction, and when the level is high, the heart rate can drop (bradycardia) while the GI tract becomes irritated, producing nausea and diarrhea. The combination of nausea, diarrhea, and a pulse below 60 beats per minute fits this pattern and is a classic warning sign that digoxin toxicity may be developing.

Other signs listed don’t align as clearly with digoxin toxicity. Dry mouth with convulsions or coma isn’t a typical early cluster of symptoms for digoxin; muscle cramps in the legs are nonspecific and not as indicative of digoxin effects, and symptoms like increased sweating with a very fast pulse point away from the common bradycardic toxicity pattern you’d expect with digoxin.

If these signs appear, the prudent step is to assess the pulse, hold the dose if the heart rate is under 60, and notify the clinician for evaluation of digoxin levels and electrolytes, since factors like potassium level can influence toxicity risk.