70 yr old male who presented with general lethargy and postural dizziness. He has a collapse the evening prior and recently had a diarrhoeal illness. His medications include warfarin, metoprolol, frusemide, allopurinol, colchicine and digoxin. Describe and interpret this ECG. LITFL Top 100 ECG
Administration of intravenous calcium has traditionally been considered a contra-indication for the treatment of hyperkalemia in the presence of digoxin toxicity. This is based on the ‘Stone Heart’ Theory: calcium may lead to an irreversible non-contractile state, due to impaired diastolic relaxation from calcium-troponin C binding
Digibind: trade name for digoxin antidote containing Digoxin-specific antibody Fab fragments; prudent to administer based on a considered risk assessment and before the life-threatening manifestations of digoxin toxicity develop
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