Substance
Digoxin and digitalis

Pathology
Excessive excitability and automaticity of myocardium resulting in conduction disturbances and dysrhythmias; AV block.

Symptoms
Anorexia, nausea, vomiting, diarrhea, headache, fatigue, weakness, drowsiness, electrolyte disturbances, confusion, delirium, visual disturbances, dysrhythmias, bradycardia, AV block, death from ventricular fibrillation.

Emergency Measures
Cardiac monitoring, activated charcoal, digoxin-specific antibody fragments (Fab) for severe toxicity, lidocaine or phenytoin for ventricular irritability. Correct electrolyte abnormalities, such as hypokalemia, immediately.

Comments
Most poisonings result from ingestion of prescribed digoxin, esp. in patients with renal failure, hypokalemia, or advanced age.