Emergency Medical Minute Tox Talks 2025 Recap 1, Digoxin and Beta Blockers
Oct 29, 2025
Preeya Prakash, MD, a cardiologist in Denver, shares insights on digoxin and beta-blocker toxicology. She explains how digoxin works and common EKG findings of toxicity. Adam Greenhaw, PharmD, dives into a digoxin overdose case, highlighting decontamination strategies and the use of Digifab. Travis Barlock, MD, discusses a beta-blocker overdose, emphasizing resuscitation techniques such as high-dose insulin therapy and ECMO considerations. The conversation is packed with critical knowledge for managing these complex cases!
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Digoxin Mechanism Links K+, Ca2+, And Vagal Tone
- Digoxin inhibits the Na+/K+ ATPase, raising extracellular potassium and increasing intracellular calcium to boost contractility.
- It also increases vagal tone, slowing SA and AV node conduction which can produce bradycardia and arrhythmias.
Why Digoxin Use Has Declined
- Digoxin use has declined as guideline-directed heart-failure therapies with mortality benefit emerged.
- It remains for rate control in atrial fibrillation or as adjunctive therapy in refractory symptomatic heart failure.
Use Activated Charcoal Early For Digoxin
- Give activated charcoal if the patient presents early (within ~2 hours) and has low aspiration risk to reduce digoxin absorption.
- Consider multi-dose charcoal for enterohepatic recirculation, especially where Digifab is unavailable.