Complications and emergencies: digoxin toxicity antidote: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Complications and emergencies: digoxin toxicity antidote

Sample item

A patient with chronic kidney disease on digoxin develops nausea, visual disturbance, bidirectional ventricular tachycardia and a serum potassium of 6.8 mmol/L. Which specific antidote is indicated?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Digoxin-specific Fab fragments

Life-threatening digoxin toxicity with ventricular arrhythmias or hyperkalaemia is treated with digoxin-specific antibody fragments, which bind free drug. Digoxin has a large volume of distribution and is not removed by dialysis. Calcium is traditionally avoided in digoxin toxicity.

Option by option

  • A. Intravenous calcium gluconate to protect the myocardium

    Calcium may worsen intracellular calcium overload in digitalis toxicity and is generally avoided.

  • B. Intravenous atropine to treat all rhythm disturbances

    Atropine can treat bradycardia but will not control the ventricular arrhythmias or hyperkalaemia.

  • C. Digoxin-specific Fab fragments (correct)

    Correct. Fab fragments bind digoxin and rapidly reverse its toxic effects.

  • D. Haemodialysis to remove the drug from the blood

    Digoxin is extensively tissue-bound, so dialysis removes very little of it.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, Digoxin-specific Fab fragments. Life-threatening digoxin toxicity with ventricular arrhythmias or hyperkalaemia is treated with digoxin-specific antibody fragments, which bind free drug.

Why is "Intravenous calcium gluconate to protect the myocardium" not the answer?

Calcium may worsen intracellular calcium overload in digitalis toxicity and is generally avoided.

Why is "Intravenous atropine to treat all rhythm disturbances" not the answer?

Atropine can treat bradycardia but will not control the ventricular arrhythmias or hyperkalaemia.

Why is "Haemodialysis to remove the drug from the blood" not the answer?

Digoxin is extensively tissue-bound, so dialysis removes very little of it.

What concept does this question test?

It tests Complications and emergencies: digoxin toxicity antidote in Anaesthesia. Digoxin has a large volume of distribution and is not removed by dialysis. Calcium is traditionally avoided in digoxin toxicity.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Complications and emergencies: digoxin toxicity antidote?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.