A patient is being treated with tab digoxin for supraventricular tachycardia. What signs and symptoms are indicative of digoxin toxicity?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2019

Explanation

Yellow vision, also known as xanthopsia, is a classic and highly specific visual disturbance indicating digoxin toxicity.
This symptom occurs because digoxin affects the sodium-potassium ATPase pump in the retinal cones, which alters color perception.
While other symptoms like nausea and bradycardia are common, yellow vision is a hallmark sign frequently tested in nursing exams.

Option A: Convulsions (seizures) are not a typical or common manifestation of digoxin toxicity. They are more commonly associated with other drug toxicities or severe electrolyte imbalances.
Option C: While dizziness or confusion can occur with digoxin toxicity due to CNS effects or decreased cardiac output, vertigo is a non-specific symptom. Yellow vision is the more definitive and classic sign.
Option D: Muscle cramping is a classic sign of hypokalemia (low potassium). While hypokalemia is a major risk factor that can lead to digoxin toxicity, the cramping itself is a symptom of the electrolyte imbalance, not a direct sign of drug toxicity.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Recognition of signs and symptoms of digoxin toxicity in acute care settings.
Nurses must always check the apical pulse for one full minute before administering digoxin and withhold the dose if the heart rate is less than 60 bpm in an adult, as bradycardia is an early sign of toxicity.
Monitoring serum potassium is critical, as hypokalemia significantly increases the risk of digoxin toxicity. A level below 3.5 mEq/L requires intervention.
What if? If the patient also had renal failure, the risk of toxicity would be even higher because digoxin is primarily cleared by the kidneys. The dose would need to be adjusted, and monitoring would be more frequent.

How to Approach the Question

Identify the core of the question: It asks for a specific sign of digoxin toxicity.
Recall the key facts about digoxin. It is a cardiac glycoside with a narrow therapeutic index, meaning the toxic dose is close to the therapeutic dose.
Review the options. Think about which symptom is most uniquely associated with digoxin.
Analyze 'Yellow vision'. This is a well-known, pathognomonic sign of digoxin toxicity (xanthopsia).
Analyze the other options. 'Muscle cramping' points to hypokalemia (a risk factor, not a direct sign). 'Convulsions' and 'Vertigo' are non-specific and not classic signs.
Conclude that 'Yellow vision' is the most accurate and specific indicator among the choices.

Concept Tested & Keywords

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E6 Pharmacology Nursing Lilley 11e Part 2 pp. 73-75, 76-78

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 758-760

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