Digi-Bind, a direct antidote in digoxin toxicity, is not always
readily available from hospital pharmacy. Moreover, it takes time to kick its
effect in.
Magnesium is an excellent choice as a temporizing anti-arrhythmic agent, particularly in ventricular tachycardia or fibrillation. 2 grams of IV magnesium sulfate can be given over 5 minutes. It is very effective in terminating digoxin induced arrhythmia. Treatment can be continued as an IV drip with 1-2 gram/hour with close monitoring to keep therapeutic level between 4 and 5 mEq/L.
Magnesium is an excellent choice as a temporizing anti-arrhythmic agent, particularly in ventricular tachycardia or fibrillation. 2 grams of IV magnesium sulfate can be given over 5 minutes. It is very effective in terminating digoxin induced arrhythmia. Treatment can be continued as an IV drip with 1-2 gram/hour with close monitoring to keep therapeutic level between 4 and 5 mEq/L.
Beside its role at intracellular level, magnesium has also been described as an indirect antagonist of digoxin.
As a side note, 2 other important aspects, which should not be ignored is
- treatment of hypo or hyper kalemia.
- Avoidance of calcium specially in the presence of hyperkalemia as it can sets in fatal ventricular tachycardia or fibrillation. This is due to the fact that intracellular calcium levels are already high in digoxin toxicity.
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