Q: All of the following are indications to treat suspected digoxin toxicity with digoxin-specific antibody (Fab) fragments except?

A) Life-threatening arrhythmia 
B) Renal dysfunction
C) Neurologic findings
D) Potassium level more than 5 meq/L
E) Elevated liver enzymes (LFT)


Answer: E

Digoxin toxicity in patients on chronic dig therapy is hard to predict, and digoxin level does not correlate with toxicity. Clinical, other laboratory parameters and EKG findings are used to predict 'dig. toxicity'. It can be very life-threatening and usually there is no luxury of time. Benefits usually outweigh risks. All of the above factors can be used to justify the use of digoxin-specific antibody (Fab) fragments, except elevated LFT.


References:

1. Bayer MJ. Recognition and management of digitalis intoxication: implications for emergency medicine. Am J Emerg Med 1991; 9:29. 

2.  Antman EM, Wenger TL, Butler VP Jr, et al. Treatment of 150 cases of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments. Final report of a multicenter study. Circulation 1990; 81:1744.