Sign of digoxin toxicity?

Appeared in: PGIMER NO - 2020

Explanation

Visual disturbances such as blurred vision, double vision (diplopia), and seeing yellow-green halos (xanthopsia) are classic and specific signs of digoxin toxicity.
These symptoms occur due to the drug's effect on the central nervous system and the retina.
While other symptoms like nausea and headache can occur, the visual changes are a hallmark sign frequently tested to identify digoxin toxicity.

Option A: Digoxin toxicity causes gastrointestinal irritation that leads to diarrhea, not constipation.
Option B: Although headache is a possible central nervous system symptom of digoxin toxicity, it is non-specific and can be caused by many other conditions.
Option D: Diarrhea is a true sign of digoxin toxicity and often an early symptom. However, visual disturbances are considered more specific and a classic hallmark of toxicity, making them a better answer in this context.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Recognition of signs and symptoms of digoxin toxicity as background academic context rather than a clinical decision trigger.
Nurses must always check the apical pulse for one full minute before administering digoxin and hold the dose if the rate is below 60 bpm in an adult, as bradycardia is a key sign of toxicity.
The therapeutic range for digoxin is very narrow (0.5-2.0 ng/mL). This small window means patients can easily become toxic, requiring vigilant nursing assessment.
Patient education is critical. Teach patients to recognize and report early signs of toxicity, especially loss of appetite, nausea, and visual changes.

How to Approach the Question

This is a factual recall question testing knowledge of a specific drug's side effects.
First, identify the keyword in the stem: 'digoxin toxicity'.
Recall the common adverse effects and signs of toxicity for digoxin. It's helpful to categorize them by body system (e.g., Cardiac, GI, CNS, Visual).
Evaluate each option against your knowledge. Note that multiple options (Headache, Diarrhea, Blurring of vision) are potential signs.
To find the 'best' answer for an exam, you must differentiate between common/early signs and specific/hallmark signs.
Recognize that while GI upset is common and early, visual disturbances (like blurred vision and halos) are the most classic and specific signs of digoxin toxicity.

Concept Tested & Keywords

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E6 Pharmacology Nursing Lilley 11e Part 2 p. 73-75

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

Practise the full PGIMER NO - 2020

Attempt every question from this paper in a timed mock, then review the full solution for each one.