Q: At what level of hyperkalemia in Dig. toxicity, treatment with digoxin Fab fragments should be considered?


Answer:  Potassium level greater than 5 mEq/L 

Digoxin toxicity may rapidly cause hyperkalemia and low threshold should be kept in view of potential life threatening situations which may arise.

Every case should be individualized and all initial treatment options should be utilized as insulin with glucose, sodium bicarbonate, correcting hypomagnesemia etc. But rapidly rising potassium, arrhythmia or altered mental status should be treated with low threshold as digoxin Fab fragments is relatively a safe option though costly.



 Reference:

 Michael J. Murray, Douglas B. Coursin, Ronald G. Pearl, Donald S. Prough - Critical Care Medicine: Perioperative Management: Published under the auspices of the American Society of Critical Care Anesthesiologists (ASCCA) / Edition 2 - Page 831