Digoxin toxicity occurs when too much of the drug digoxin is present in the bloodstream. In this mnemonic video, we'll cover the important facts about digoxin toxicity, so you'll be ready come test day. In today's video, we're at a beachside concert where the famous DJ Oxxn are playing.
The DJ Oxxn will serve as your memory anchor to digoxin, since DJ Oxxn sounds like did joxn, right? DJs are always making remixes, and the DJ Oxen's biggest hit is their remake of Britney Spears'song Toxic, which they've called Toxic 2.0. Use this to help you remember that digoxin becomes toxic when its blood levels rise above 2.0 nanograms per milliliter.
If toxicity is suspected, you should hold the medication and notify the provider, who will likely order a blood draw to test the digoxin level. That said, it's possible for patients to show signs of toxicity even when their digoxin levels are below 2.0. For this reason, it's important to recognize the signs of digoxin toxicity.
On this note, let's talk about the early signs of digoxin toxicity, which we've grouped in the back left of the scene. A person is leaving the beach early because he has food poisoning. The way this guy is leaving early should help you remember that the following symbols represent early signs of toxicity. These symptoms generally start to appear when digoxin levels rise just above the therapeutic range.
It's important to watch for these early signs of toxicity and to intervene immediately if noticed. The man leaving the beach just came out of the porta potty which is now covered in diarrhea. Whatever the guy ate is clearly not sitting well in his stomach. Which reminds me, one of the early signs of digoxin toxicity is diarrhea.
The guy with an upset stomach is now vomiting, which can help you remember that nausea and vomiting are other early signs of digoxin toxicity. This guy's stomach is really churning. He's grabbing his abdomen in pain, which should help you remember that abdominal pain and cramping is also an early sign of digoxin toxicity. The man left his food outside while he was in the bathroom. Now that he is feeling so sick, he has obviously lost his appetite.
The way the man has no appetite should help you remember that... early digoxin toxicity can cause loss of appetite. You may see some resources phrase this as anorexia, which is just another way of saying appetite loss. Notice that all of these early signs of digoxin toxicity are related to the gastrointestinal system. As the nurse, it's important to educate the patient to report any GI symptoms, since these could be early warning signs that the digoxin level has risen above the normal range.
Next, let's talk about the late signs of digoxin toxicity, which we've grouped on the right side of the scene. This beach is well known for its workout equipment, and people often come here to exercise and enjoy the beautiful ocean view. The beach gym is staying open late for the party tonight, so people can work out while listening to the DJ Oxen's music.
The way the gym is open late can help you remember that the following symbols represent the late signs of toxicity. They are symptoms observed when digoxin levels rise very high. or when digoxin levels are elevated over a long period of time.
Since these late symptoms can be life-threatening, it's important to recognize them and take action immediately. These symptoms can be grouped into three categories cardiovascular, neurological, and visual. Let's start with some cardiovascular signs of digoxin toxicity.
Near the gym, someone brought an inflatable turtle to lounge on in the ocean. Notice that this turtle is heart-shaped and that it's moving slowly in the water. This slow, heart-shaped turtle should help you remember that a late sign of digoxin toxicity is bradycardia, meaning an abnormally slow heart rate. If the patient's heart rate falls below 60 beats per minute, it could be a sign that the patient is experiencing digoxin toxicity.
The DJs brought extra equipment so that people all around the beach could watch the show and hear the music. However, the equipment by the gym got wet and sandy and is malfunctioning. The speakers are screeching with feedback and the screen is showing static. Looking closer, don't you think this static looks kind of like an arrhythmia on an EKG?
This arrhythmia-like static is our symbol for arrhythmias. Severe digoxin toxicity can lead to dangerous cardiac arrhythmias. If a patient has suspected digoxin toxicity, it's recommended that they are put on cardiac monitoring so that any arrhythmias can be diagnosed and treated. Next, let's move on to the late signs of digoxin toxicity that are neurological.
The screeching of the malfunctioning speaker is giving the guy nearby a headache. This should help you remember another late sign of digoxin toxicity is headache. Another guy at the party is wanting to show off for some girls, and what better way to impress a girl than by lifting heavy weights?
Unfortunately, the guy is too weak to lift the weights and ended up just looking silly. The way he is weak should help you remember that weakness is another late sign of digoxin toxicity. Patients experiencing this side effect will often report a sense of heaviness in their arms and legs or might express difficulty performing normal, everyday tasks. The girl waiting for the boy to do something impressive is standing nearby, confused. She doesn't understand why he thought this would impress her.
This can help you remember that confusion is another late sign of digoxin toxicity. Patients with confusion may report difficulty concentrating, a mental fog, or an altered level of awareness. The partiers are getting exhausted from working out to the DJ Oxen's music.
One is lying down, fatigued, on the inflatable turtle. Which reminds me, another late symptom of digoxin toxicity is fatigue. The last late sign of digoxin toxicity has to do with vision. Notice that this guy has yellow tinted sunglasses. They're made really cheaply so they make things blurry, but it's worth it to look cool.
The yellow blurry glasses should remind you of yellow blurred vision. Because we're looking towards the sunlight, there are also some light halos near the glasses. This should help you remember that patients with digoxin toxicity might also complain of halos appearing around lights. If a patient taking digoxin starts to notice vision changes, especially if they're experiencing yellow, blurry vision with halos, their digoxin levels should be checked, as this is a late sign of toxicity.
Let's move on to cover some things that increase the risk of developing toxicity. A nearby food truck is selling bananas, but there aren't enough garbage cans on the beach, and banana peels are ending up on the ground. We use bananas to symbolize potassium, so this empty banana peel symbolizes low potassium levels, also called hypokalemia.
A DJ Ox is walking around the beach trying to sell the new DJ Oxen record. He didn't see a banana peel on the ground and slipped, causing the toxic albums to fly up in the air. You could even say the banana peel caused a rise in toxic.
This can help you remember that hypokalemia increases the risk of digoxin toxicity. Hypokalemia makes cells in the body more responsive to the effects of digoxin. This is why patients taking digoxin should have their potassium levels monitored regularly. The beach has an elaborate fountain display of two cherubs urinating.
You might even call it the diurinate fountain. Di because there are two cherubs and urinate because, well, that's what the cherubs are doing. The diurinate fountain is our symbol for diuretics, drugs that increase urination.
There is caution tape around the diurinate fountain so that dancing, drunk party people don't accidentally collide with the fountain. We don't want people to get hurt, and we don't want the fountain to break. The caution tape around the diurinate fountain should help you remember that digoxin must be used cautiously with diuretics. Several types of diuretics, including lube and thiazide diuretics, cause hypokalemia as a side effect. And, like we already mentioned, hypokalemia increases the risk of digoxin toxicity.
Patients who need to take both a diuretic and digoxin may also be given a potassium supplement to ensure that their potassium level doesn't fall below the normal range. The food truck I mentioned before is parked at the back of the beach. There are so many people at the party and they are starting to run out of food.
They want to keep selling food and making money, though, so they've resorted to using damaged cans of kidney beans, which have a use with caution note attached to them. So that's why the guy leaving early has food poisoning. These damaged kidney beans symbolize kidney damage, and the use with caution note symbolizes how digoxin should be used with caution in patients with kidney damage.
Digoxin is excreted by the kidneys, so decreased kidney function causes the drug to accumulate in the blood and increases the risk for toxicity. It's important to monitor kidney function through BUN and creatinine levels in patients taking digoxin. With the DJ Oxen party going on, the beach is full of loud music and crazy people. However, old people also like to walk along the beach, and as you know, the elderly can be unsteady on their feet.
A sign is on the beach warning party guests to be cautious, especially around the elderly. This sign telling people to use caution around the elderly should help you remember that digoxin should be used cautiously in the elderly. Elderly patients are at an increased risk of digoxin toxicity for several reasons.
They tend to have worse kidney function, which, like we talked about earlier, causes digoxin to accumulate in the blood. The elderly are also often taking other medications that can cause drug interactions with digoxin. In order to maintain digoxin levels within a normal range, elderly patients may require closer monitoring. Finally, let's talk about the antidote for digoxin toxicity. The symbol for this fact is in the bottom left of the scene.
Some of the DJ Oxum were getting too rowdy and partying too hard. The rest of the DJ team was worried they were going to break their expensive DJ equipment and possibly even hurt the guests at the party. That's why they had to bind them up.
These bound DJ auxin should help you remember the drug Digibind. DigiBind, which you may also hear called Digoxin Immune FAB, is the antidote to digoxin toxicity. Like its name suggests, DigiBind binds to digoxin and promotes its excretion from the body. It is usually reserved for severe cases of digoxin toxicity, in which cardiac arrhythmias put the patient's life at risk.
Alright, that's all for this mnemonic. Let's recap. Digoxin toxicity occurs when too much digoxin is present in the bloodstream.
Symptoms of toxicity start to appear when levels of digoxin rise above 2.0. Early signs of toxicity are often GI-related and include diarrhea, nausea, vomiting, abdominal pain, and loss of appetite. Late signs of toxicity include cardiovascular symptoms such as bradycardia and arrhythmias, neurological symptoms such as headache, weakness, confusion, and fatigue, and visual symptoms such as blurred yellow vision with halos. A A big risk factor for digoxin toxicity is hypokalemia, so digoxin should be used cautiously in patients taking diuretics, which alter potassium levels. Digoxin should also be used cautiously in patients with kidney damage and the elderly.
Severe cases of digoxin toxicity can be treated with DigiBind. And now we're actually done with digoxin toxicity. See you next time!
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