A 5-year-old swallowed three digoxin tablets several hours ago. He is lethargic with BP 74/40 and R 8. What should you do?

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Multiple Choice

A 5-year-old swallowed three digoxin tablets several hours ago. He is lethargic with BP 74/40 and R 8. What should you do?

In severe digoxin poisoning, the immediate danger is poor perfusion from hypotension and bradycardia, so the priority is rapid hemodynamic support while arranging definitive antidotal therapy. Epinephrine provides quick, broad support: it increases heart rate and contractility through beta-1 effects and raises vascular tone with alpha-1 effects, which helps raise blood pressure and improve perfusion in this hypoperfused child. Atropine might help bradycardia, but it won’t reliably correct the dangerous hypotension or improve perfusion on its own. Glucagon is not effective for digoxin toxicity. Gastric lavage isn’t useful several hours after ingestion. The definitive antidote is digoxin-specific Fab fragments, but that option isn’t listed here, so epinephrine is the appropriate immediate measure to stabilize the patient.

In severe digoxin poisoning, the immediate danger is poor perfusion from hypotension and bradycardia, so the priority is rapid hemodynamic support while arranging definitive antidotal therapy. Epinephrine provides quick, broad support: it increases heart rate and contractility through beta-1 effects and raises vascular tone with alpha-1 effects, which helps raise blood pressure and improve perfusion in this hypoperfused child.

Atropine might help bradycardia, but it won’t reliably correct the dangerous hypotension or improve perfusion on its own. Glucagon is not effective for digoxin toxicity. Gastric lavage isn’t useful several hours after ingestion. The definitive antidote is digoxin-specific Fab fragments, but that option isn’t listed here, so epinephrine is the appropriate immediate measure to stabilize the patient.

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