A 72-year-old woman on chronic digoxin therapy presents with nausea, confusion, and reports yellow-green discoloration of vision. ECG shows frequent premature ventricular complexes, and serum potassium is 6.2 mEq/L. The most appropriate immediate treatment is:
- A IV insulin with dextrose
- B Oral potassium chloride replacement
- C Digoxin-specific antibody fragments (Fab) ✓
- D IV magnesium sulfate
Correct answer: C. Digoxin-specific antibody fragments (Fab)
Explanation
Severe digoxin toxicity with life-threatening arrhythmias or significant hyperkalemia (K+ >5 mEq/L) mandates digoxin immune Fab, which binds circulating digoxin and promotes renal excretion of the complex. Hyperkalemia here reflects poisoning of the Na+/K+-ATPase, not potassium excess, so insulin or potassium would be wrong. Magnesium is used for torsades, not digitalis arrhythmias. Xanthopsia is a classic clue to digoxin accumulation.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.