These patients may present with a variety of types of arrhythmias, most being ventricular. Other effects seen include nausea, vomiting, visual disturbances and altered mental status. Binds primarily to cardiac muscle with little drug found in fat. The half-life in patients with normal renal function is approximately 1.6 days. In massive acute overdose, the half-life may decrease to 13 hours.
Digoxin follows multiphasic distribution.
Digoxin levels drawn within 4-6 hours of ingestion have not distributed completely and will show falsely elevated values. Respiratory and cardiovascular support should be provided as necessary. Patients who are hypotensive may require placement of a CVP line. Lavage or ipecac may be used but there is no evidence is that it provides additional benefit over charcoal alone in digoxin overdoses and additional vagal stimulation may worsen bradycardia. Activated charcoal also will bind drug undergoing enterohepatic recirculation.