digoxin toxicity
Enable an AI agent to recognize suspected digoxin toxicity, assess its evolving severity and support clinician-directed investigation, escalation and recovery monitoring.
Bundle → Layer → Finding → Questions Filled
7 bundles · 13 layers · 19 findings · 31 questions
Exposure and attribution Establish which digoxin exposure could explain the episode.
Digoxin exposure reconstruction
Reconcile intended treatment with actual intake.
Exposure pattern and amount
Record acute, chronic or mixed exposure with explicit uncertainty about amount and timing.
- What dose, formulation, route and administration times are supported by prescriptions, packaging or administration records? provenance
- Does the timeline support acute excess intake, chronic accumulation or an acute-on-chronic episode? definition
Causal boundary
Assess whether digoxin explains the observed harm.
Digoxin-specific attribution
Keep exposure evidence, clinical attribution and competing explanations separately reviewable.
- What evidence identifies digoxin rather than another cardiac glycoside? provenance
- Could baseline heart disease, another medicine or an independent illness better explain the presentation? boundary
Accumulation and susceptibility Explain why the patient's exposure became harmful.
Renal clearance context
Relate renal changes to the dosing timeline.
Clearance-dose mismatch
Impaired renal function can prolong digoxin elimination. [Digoxin prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9ca08b66-55eb-4155-a8bd-6fa2282adab4)
- How did renal function change before symptoms developed? measurement
- Was the digoxin regimen reassessed when renal function or body weight changed? provenance
Electrolyte and medication context
Capture susceptibility and possible precipitating changes.
Susceptibility and interactions
Low potassium, low magnesium and high calcium can predispose to toxicity. [Digoxin prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9ca08b66-55eb-4155-a8bd-6fa2282adab4)
- Which electrolyte abnormalities preceded the episode, and which appeared during it? measurement
- Which recently started, stopped or changed medicines require a verified digoxin-interaction review? action
Clinical expression and severity Describe the observed syndrome and its immediate consequences.
Cardiac manifestations
Record electrical abnormalities and their circulatory consequences.
Rhythm and perfusion
Conduction block, atrial tachycardia with block and ventricular arrhythmias are recognized manifestations. [Digoxin prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9ca08b66-55eb-4155-a8bd-6fa2282adab4)
- Which rhythm or conduction changes are new compared with prior ECGs? measurement
- Do the current rhythm, blood pressure and perfusion findings require immediate emergency escalation? action
Extracardiac manifestations
Assess symptoms that support recognition but have competing causes.
Symptom constellation
Nausea, vomiting, anorexia, confusion and visual changes may accompany toxicity. [Digoxin prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9ca08b66-55eb-4155-a8bd-6fa2282adab4)
- Which symptoms appeared after the relevant exposure or treatment change? provenance
- Which symptoms remain better explained by the underlying illness or another cause? boundary
Laboratory interpretation Determine what measured digoxin and electrolyte results can establish.
Sampling and assay context
Attach pharmacological timing and laboratory limitations to each result.
Interpretable digoxin result
Routine digoxin sampling is recommended before the next dose or at least six hours after the last dose. [Digoxin prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9ca08b66-55eb-4155-a8bd-6fa2282adab4)
- How long after the last dose and before or after Fab was the sample collected? measurement
- What assay was used, and has the laboratory identified interference or another interpretive limitation? provenance
Integrated result assessment
Relate concentrations and electrolyte trends to the bedside assessment.
Clinical-laboratory concordance
Record whether laboratory trends support or conflict with the working attribution and severity assessment.
- How do serial digoxin and potassium measurements align with the ECG and clinical trajectory? measurement
- Does disagreement require reassessment of sampling time, assay reliability or the diagnosis? action
Intervention and antidote response Represent clinician-directed action and its observed consequences.
Escalation and Fab assessment
Connect severity to specialist review and antidote decisions.
Antidote decision
Digoxin-specific immune Fab can reverse life-threatening dysrhythmias; toxicology consultation supports treatment decisions. [AHA poisoning update](https://professional.heart.org/en/science-news/2023-american-heart-association-focused-update-on-the-management-of-patients-with-cardiac-arrest/top-things-to-know)
- Which clinical findings warrant immediate toxicology consultation and Fab assessment? action
- Which applicable protocol and patient evidence support the clinician's treatment decision and dose? provenance
Post-Fab assessment
Track clinical response while accounting for changed laboratory interpretation.
Response and treatment effects
After Fab, total digoxin can rise despite neutralization; monitor for hypokalemia and deterioration of the underlying cardiac condition. [DIGIFAB prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c05ee6a5-c98b-45f4-83fd-40781639d653)
- How did rhythm, perfusion, symptoms and potassium change after each intervention? measurement
- Is apparent deterioration persistent toxicity, recurrent toxicity or a treatment-associated complication? boundary
Resolution and recurrence Define episode closure and reduce the chance of another episode.
Sustained recovery
Assess whether improvement persists over an appropriate observation period.
Recurrence surveillance
Severe renal failure warrants prolonged monitoring after Fab for possible recurrent toxicity. [DIGIFAB prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c05ee6a5-c98b-45f4-83fd-40781639d653)
- What observation period and clinical endpoints has the treating team selected for this exposure and renal context? action
- Have symptoms or electrical abnormalities recurred after initial improvement? measurement
Future exposure control
Link episode closure to correction of the precipitating circumstances.
Precipitant correction and regimen review
Record how the identified cause was addressed and who owns any subsequent digoxin decision.
- What verified changes address the implicated dosing error, interaction or change in clearance? action
- Who will reassess the ongoing digoxin indication, any restart and follow-up monitoring? action
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Check these first
Recalled without web access and unsourced; every item is a lead to verify.
- Which of these check these first hold for the sense of digoxin toxicity this model covers, and on what evidence? provenance
Kinds and varieties
Recalled without web access and unsourced; every item is a lead to verify.
- Which of these kinds and varieties hold for the sense of digoxin toxicity this model covers, and on what evidence? provenance
Real-world use
Recalled without web access and unsourced; every item is a lead to verify.
- Which of these real-world use hold for the sense of digoxin toxicity this model covers, and on what evidence? provenance
Typical measurements
Recalled without web access and unsourced; every item is a lead to verify.
- Which of these typical measurements hold for the sense of digoxin toxicity this model covers, and on what evidence? provenance
Failure modes and hazards
Recalled without web access and unsourced; every item is a lead to verify.
- Which of these failure modes and hazards hold for the sense of digoxin toxicity this model covers, and on what evidence? provenance
Regional variation
Recalled without web access and unsourced; every item is a lead to verify.
- Which of these regional variation hold for the sense of digoxin toxicity this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Recalled without web access and unsourced; every item is a lead to verify.
- Which of these neighbouring kinds and how to tell them apart hold for the sense of digoxin toxicity this model covers, and on what evidence? provenance
Classifiers Filled
- Family
- Thing Registry
- Category
- Information and virtual systems
- Entry kind
- thing
- Plane
- INF
- Domain
- INF.MED
What it is Filled
Digoxin toxicity is a clinical syndrome caused by excessive digoxin effects, especially disruption of cardiac conduction and automaticity through sodium-potassium ATPase inhibition, arising after acute overdose or during ongoing therapy.
In scope
- Acute overdose, chronic accumulation and acute exposure superimposed on established treatment
- Evidence connecting digoxin exposure to clinical harm
- Interpretation of timed digoxin measurements alongside clinical observations
- Cardiac manifestations, electrolyte disturbances and renal context
- Escalation, antidote decisions and monitoring for recurrent toxicity
Out of scope
- Digoxin as a chemical substance or pharmaceutical product
- Routine prescribing for heart failure or atrial fibrillation outside a toxicity episode
- Poisoning by digitoxin, oleander or other cardiac glycosides
- Independent models of kidney disease, electrolyte disorders and arrhythmias
- Manufacture and procurement of digoxin immune Fab
Why it exists Filled
Enable an AI agent to recognize suspected digoxin toxicity, assess its evolving severity and support clinician-directed investigation, escalation and recovery monitoring.
Distinguishing features Filled
- Require evidence implicating digoxin specifically; an unidentified cardiac glycoside exposure remains a neighbouring diagnostic possibility.
- Separate a clinical toxicity assessment from an isolated elevated concentration; toxicity can occur at lower concentrations. [Digoxin prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9ca08b66-55eb-4155-a8bd-6fa2282adab4)
- Distinguish expected treatment effects from new symptomatic conduction disturbance or arrhythmia through comparison with baseline.
- Separate acute excess intake from accumulation during ongoing treatment by reconstructing administration and renal-function timelines.
- After digoxin immune Fab, distinguish total measured digoxin from free digoxin because routine concentrations can mislead. [DIGIFAB prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c05ee6a5-c98b-45f4-83fd-40781639d653)
What robots and AI may and may not do Filled
Must not
- Diagnose toxicity or interpret a person's drug levels.
- Advise on dosing, stopping or restarting digoxin.
- Provide information that helps anyone harm themselves or others with the drug.
- Delay emergency help for a suspected poisoning.
Only with a human decision
- All treatment decisions, made by clinicians.
May
- Explain what digoxin toxicity is and its warning signs from medical sources.
- Direct anyone with suspected toxicity to emergency care or a poison centre.
Moral aspects Filled
- Older people on long-term treatment are at particular risk, and poisoning can be fatal.
- Information about overdose must stay focused on safety and treatment.
Who is affected
- Patients on digoxin
- Older people
- Caregivers
Owners Filled
Steward
Nobody owns the condition; the treating clinician answers for each patient.
Links to other meta-models Filled
parent
- Q387175 - registry parent class
What else AI and robots need to interact with it Filled
Identity and identifiers required Filled
- Vercy registry: vr.tr.digoxin-toxicity
- Wikidata: Q151350 (https://www.wikidata.org/wiki/Q151350)
Direct properties not applicable Not applicable
- Exposure pattern: acute; chronic accumulation; acute-on-chronic; uncertain
- Digoxin attribution: suspected; supported; uncertain; alternative explanation favoured
- Administered or ingested amount: micrograms or milligrams, with formulation, route, timestamps and uncertainty
- Serum digoxin concentration: ng/mL, with collection time, last-dose interval, assay type and Fab status
- Cardiac electrical state: documented rhythm, conduction abnormalities and change from baseline
- Circulatory stability: heart rate in beats/min; blood pressure in mmHg; perfusion observations
- Electrolyte trajectory: potassium, magnesium and calcium in explicitly recorded laboratory units, with timestamps
- Renal function trajectory: creatinine in mg/dL or micromol/L; renal estimate with method and units; urine output
- Precipitating treatment change: linked dose change, interacting medication, dispensing error or administration error
- Fab treatment status: not considered; under assessment; indicated; administered; repeat assessment required
Plane INF: no invented physical properties.
Recognition optional Filled
- Not visible directly; signs include nausea, confusion and visual changes such as yellow-green vision.
- Diagnosed by heart rhythm tests and blood tests.
Capabilities and actions required Filled
- Reconstruct a digoxin exposure timeline and flag missing or contradictory evidence.
- Compare symptoms, ECG findings and laboratory trends with the patient's baseline.
- Flag digoxin results whose timing or assay context limits interpretation.
- Escalate suspected serious toxicity to the responsible clinical team and toxicology service.
- Assemble evidence for clinician-directed interruption of exposure and antidote assessment.
- Track response, recurrence and correction of the precipitating cause.
Hazards and failure modes required Filled
- Life-threatening heart rhythm disturbances.
- Interactions with other medicines and kidney problems raise risk.
Standards and interfaces required Filled
- The International Classification of Diseases, Tenth Revision, issued by the World Health Organization includes category T46.0 for poisoning by cardiac-stimulant glycosides and drugs of similar action, covering digoxin poisoning.
Context of use required Filled
- Digoxin toxicity is encountered in emergency care, cardiology and medication monitoring when excessive drug effects are suspected.
- The diagnosis supports clinical interpretation of rhythm disturbances and other symptoms alongside medication history, kidney function, electrolytes and laboratory findings.
Sources Filled
- Wikidata item Q151350: digoxin toxicity - identity and sense of the item
- Wikipedia: Digoxin toxicity - general description of the item
Open questions
- Which operational diagnostic criteria best distinguish chronic digoxin toxicity from overlapping illness when the concentration is not markedly elevated?
- How should current guidelines and product labeling be reconciled for Fab initiation and dosing in acute, chronic and acute-on-chronic presentations?
- Which observation and recurrence-monitoring endpoints are supported for different degrees of renal impairment after Fab?
- Which local assays reliably measure free digoxin after Fab, and what assay-specific limitations must the model encode?
- Which recognition and escalation criteria require separate treatment for infants, children and frail older adults?
Machine files
Provenance
thing registry research (pass 2) · unreviewed
Built from: models/things/publications/thing-q151350/spec.json