A 66-year-old woman on digoxin for atrial fibrillation, with recent worsening renal function, presents with nausea, anorexia and xanthopsia. ECG shows an atrial tachycardia at 160 bpm with 2:1 AV block and frequent ventricular ectopy. What is the definitive treatment?
- A Digoxin-specific antibody fragments (Fab) ✓
- B Increase digoxin dose for better rate control
- C Oral amiodarone initiation
- D Carotid sinus massage
Correct answer: A. Digoxin-specific antibody fragments (Fab)
Explanation
Paroxysmal atrial tachycardia with AV block, gastrointestinal symptoms and xanthopsia constitute classic digoxin toxicity, aggravated by renal impairment. Digoxin-specific Fab fragments bind free digoxin and reverse toxicity definitively, and are indicated when significant arrhythmias are present. Giving more digoxin would be lethal. Amiodarone raises digoxin levels by displacing tissue binding and reducing clearance, so it perpetuates rather than treats the problem.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.