{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T09:11:06Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 23.8, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094e1-1d6a-7952-98fc-40f99a977796\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: digoxin toxicity\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 043: 100", "usd": 0.0, "recall": true }, "codex": { "seconds": 91.1, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094e1-1d69-71f0-832a-b8d734d9fc51\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: digoxin toxicity\nRegistry id: vr.tr.digoxin-toxicity\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entry:" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:46:39+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "visual_identification" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:26+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q151350", "registryId": "vr.tr.digoxin-toxicity", "name": "digoxin toxicity", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q151350/", "model": { "registry_id": "vr.tr.digoxin-toxicity", "name": "digoxin toxicity", "purpose": "Enable an AI agent to recognize suspected digoxin toxicity, assess its evolving severity and support clinician-directed investigation, escalation and recovery monitoring.", "definition": "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.", "scope_statement": "This model owns the clinical toxicity episode attributable to digoxin for vr.tr.digoxin-toxicity in XCT / XCT.STA, including exposure attribution, diagnostic uncertainty, physiological consequences and response to intervention.", "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" ], "distinguishing_features": [ "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)" ], "characteristics": [ { "name": "Exposure pattern", "kind": "category", "unit_or_values": "acute; chronic accumulation; acute-on-chronic; uncertain", "why_it_matters": "Organizes the exposure reconstruction and interpretation of subsequent observations." }, { "name": "Digoxin attribution", "kind": "state", "unit_or_values": "suspected; supported; uncertain; alternative explanation favoured", "why_it_matters": "Keeps diagnostic confidence distinct from urgency." }, { "name": "Administered or ingested amount", "kind": "measurement", "unit_or_values": "micrograms or milligrams, with formulation, route, timestamps and uncertainty", "why_it_matters": "Enables comparison of intended treatment with reconstructed exposure." }, { "name": "Serum digoxin concentration", "kind": "measurement", "unit_or_values": "ng/mL, with collection time, last-dose interval, assay type and Fab status", "why_it_matters": "Makes the laboratory result interpretable within the episode." }, { "name": "Cardiac electrical state", "kind": "state", "unit_or_values": "documented rhythm, conduction abnormalities and change from baseline", "why_it_matters": "Records the cardiac manifestation requiring assessment." }, { "name": "Circulatory stability", "kind": "measurement", "unit_or_values": "heart rate in beats/min; blood pressure in mmHg; perfusion observations", "why_it_matters": "Supports urgency assessment independently of concentration." }, { "name": "Electrolyte trajectory", "kind": "measurement", "unit_or_values": "potassium, magnesium and calcium in explicitly recorded laboratory units, with timestamps", "why_it_matters": "Preserves direction of change and its relationship to exposure and treatment." }, { "name": "Renal function trajectory", "kind": "measurement", "unit_or_values": "creatinine in mg/dL or micromol/L; renal estimate with method and units; urine output", "why_it_matters": "Supports assessment of clearance and observation needs." }, { "name": "Precipitating treatment change", "kind": "relation", "unit_or_values": "linked dose change, interacting medication, dispensing error or administration error", "why_it_matters": "Connects the episode to a potentially correctable cause." }, { "name": "Fab treatment status", "kind": "state", "unit_or_values": "not considered; under assessment; indicated; administered; repeat assessment required", "why_it_matters": "Connects clinical decisions, assay interpretation and response monitoring." } ], "affordances": [ "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." ], "agent_conduct": { "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." ], "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." ], "requires_human": [ "All treatment decisions, made by clinicians." ] }, "ethics": { "considerations": [ "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." ], "affected_parties": [ "Patients on digoxin", "Older people", "Caregivers" ] }, "owners": { "steward": "Nobody owns the condition; the treating clinician answers for each patient.", "master_systems": [] }, "visual_identification": [ "Not visible directly; signs include nausea, confusion and visual changes such as yellow-green vision.", "Diagnosed by heart rhythm tests and blood tests." ], "failure_modes_and_hazards": [ "Life-threatening heart rhythm disturbances.", "Interactions with other medicines and kidney problems raise risk." ], "what_it_is_for": [ "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." ], "standards_and_regulation": [ "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." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q151350: digoxin toxicity", "url": "https://www.wikidata.org/wiki/Q151350", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Digoxin toxicity", "url": "https://en.wikipedia.org/wiki/Digoxin_toxicity", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "exposure-and-attribution", "name": "Exposure and attribution", "description": "Establish which digoxin exposure could explain the episode.", "rationale": "Exposure identity and chronology distinguish this condition from related poisoning syndromes.", "layers": [ { "id": "digoxin-exposure-reconstruction", "name": "Digoxin exposure reconstruction", "description": "Reconcile intended treatment with actual intake.", "findings": [ { "id": "exposure-pattern-and-amount", "name": "Exposure pattern and amount", "description": "Record acute, chronic or mixed exposure with explicit uncertainty about amount and timing.", "questions": [ { "text": "What dose, formulation, route and administration times are supported by prescriptions, packaging or administration records?", "kind": "provenance", "id": "exposure-pattern-and-amount-q01" }, { "text": "Does the timeline support acute excess intake, chronic accumulation or an acute-on-chronic episode?", "kind": "definition", "id": "exposure-pattern-and-amount-q02" } ] } ] }, { "id": "causal-boundary", "name": "Causal boundary", "description": "Assess whether digoxin explains the observed harm.", "findings": [ { "id": "digoxin-specific-attribution", "name": "Digoxin-specific attribution", "description": "Keep exposure evidence, clinical attribution and competing explanations separately reviewable.", "questions": [ { "text": "What evidence identifies digoxin rather than another cardiac glycoside?", "kind": "provenance", "id": "digoxin-specific-attribution-q01" }, { "text": "Could baseline heart disease, another medicine or an independent illness better explain the presentation?", "kind": "boundary", "id": "digoxin-specific-attribution-q02" } ] } ] } ] }, { "id": "accumulation-and-susceptibility", "name": "Accumulation and susceptibility", "description": "Explain why the patient's exposure became harmful.", "rationale": "An episode may arise during prescribed treatment without an obvious overdose.", "layers": [ { "id": "renal-clearance-context", "name": "Renal clearance context", "description": "Relate renal changes to the dosing timeline.", "findings": [ { "id": "clearance-dose-mismatch", "name": "Clearance-dose mismatch", "description": "Impaired renal function can prolong digoxin elimination. [Digoxin prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9ca08b66-55eb-4155-a8bd-6fa2282adab4)", "questions": [ { "text": "How did renal function change before symptoms developed?", "kind": "measurement", "id": "clearance-dose-mismatch-q01" }, { "text": "Was the digoxin regimen reassessed when renal function or body weight changed?", "kind": "provenance", "id": "clearance-dose-mismatch-q02" } ] } ] }, { "id": "electrolyte-and-medication-context", "name": "Electrolyte and medication context", "description": "Capture susceptibility and possible precipitating changes.", "findings": [ { "id": "susceptibility-and-interactions", "name": "Susceptibility and interactions", "description": "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)", "questions": [ { "text": "Which electrolyte abnormalities preceded the episode, and which appeared during it?", "kind": "measurement", "id": "susceptibility-and-interactions-q01" }, { "text": "Which recently started, stopped or changed medicines require a verified digoxin-interaction review?", "kind": "action", "id": "susceptibility-and-interactions-q02" } ] } ] } ] }, { "id": "clinical-expression-and-severity", "name": "Clinical expression and severity", "description": "Describe the observed syndrome and its immediate consequences.", "rationale": "The model must support urgency assessment even when exposure estimates or laboratory results are incomplete.", "layers": [ { "id": "cardiac-manifestations", "name": "Cardiac manifestations", "description": "Record electrical abnormalities and their circulatory consequences.", "findings": [ { "id": "rhythm-and-perfusion", "name": "Rhythm and perfusion", "description": "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)", "questions": [ { "text": "Which rhythm or conduction changes are new compared with prior ECGs?", "kind": "measurement", "id": "rhythm-and-perfusion-q01" }, { "text": "Do the current rhythm, blood pressure and perfusion findings require immediate emergency escalation?", "kind": "action", "id": "rhythm-and-perfusion-q02" } ] } ] }, { "id": "extracardiac-manifestations", "name": "Extracardiac manifestations", "description": "Assess symptoms that support recognition but have competing causes.", "findings": [ { "id": "symptom-constellation", "name": "Symptom constellation", "description": "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)", "questions": [ { "text": "Which symptoms appeared after the relevant exposure or treatment change?", "kind": "provenance", "id": "symptom-constellation-q01" }, { "text": "Which symptoms remain better explained by the underlying illness or another cause?", "kind": "boundary", "id": "symptom-constellation-q02" } ] } ] } ] }, { "id": "laboratory-interpretation", "name": "Laboratory interpretation", "description": "Determine what measured digoxin and electrolyte results can establish.", "rationale": "Sampling conditions and antidote exposure can change the meaning of the same reported concentration.", "layers": [ { "id": "sampling-and-assay-context", "name": "Sampling and assay context", "description": "Attach pharmacological timing and laboratory limitations to each result.", "findings": [ { "id": "interpretable-digoxin-result", "name": "Interpretable digoxin result", "description": "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)", "questions": [ { "text": "How long after the last dose and before or after Fab was the sample collected?", "kind": "measurement", "id": "interpretable-digoxin-result-q01" }, { "text": "What assay was used, and has the laboratory identified interference or another interpretive limitation?", "kind": "provenance", "id": "interpretable-digoxin-result-q02" } ] } ] }, { "id": "integrated-result-assessment", "name": "Integrated result assessment", "description": "Relate concentrations and electrolyte trends to the bedside assessment.", "findings": [ { "id": "clinical-laboratory-concordance", "name": "Clinical-laboratory concordance", "description": "Record whether laboratory trends support or conflict with the working attribution and severity assessment.", "questions": [ { "text": "How do serial digoxin and potassium measurements align with the ECG and clinical trajectory?", "kind": "measurement", "id": "clinical-laboratory-concordance-q01" }, { "text": "Does disagreement require reassessment of sampling time, assay reliability or the diagnosis?", "kind": "action", "id": "clinical-laboratory-concordance-q02" } ] } ] } ] }, { "id": "intervention-and-antidote-response", "name": "Intervention and antidote response", "description": "Represent clinician-directed action and its observed consequences.", "rationale": "Serious toxicity creates time-sensitive decisions whose justification must remain traceable.", "layers": [ { "id": "escalation-and-fab-assessment", "name": "Escalation and Fab assessment", "description": "Connect severity to specialist review and antidote decisions.", "findings": [ { "id": "antidote-decision", "name": "Antidote decision", "description": "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)", "questions": [ { "text": "Which clinical findings warrant immediate toxicology consultation and Fab assessment?", "kind": "action", "id": "antidote-decision-q01" }, { "text": "Which applicable protocol and patient evidence support the clinician's treatment decision and dose?", "kind": "provenance", "id": "antidote-decision-q02" } ] } ] }, { "id": "post-fab-assessment", "name": "Post-Fab assessment", "description": "Track clinical response while accounting for changed laboratory interpretation.", "findings": [ { "id": "response-and-treatment-effects", "name": "Response and treatment effects", "description": "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)", "questions": [ { "text": "How did rhythm, perfusion, symptoms and potassium change after each intervention?", "kind": "measurement", "id": "response-and-treatment-effects-q01" }, { "text": "Is apparent deterioration persistent toxicity, recurrent toxicity or a treatment-associated complication?", "kind": "boundary", "id": "response-and-treatment-effects-q02" } ] } ] } ] }, { "id": "resolution-and-recurrence", "name": "Resolution and recurrence", "description": "Define episode closure and reduce the chance of another episode.", "rationale": "Initial improvement does not by itself establish sustained recovery or a safe future regimen.", "layers": [ { "id": "sustained-recovery", "name": "Sustained recovery", "description": "Assess whether improvement persists over an appropriate observation period.", "findings": [ { "id": "recurrence-surveillance", "name": "Recurrence surveillance", "description": "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)", "questions": [ { "text": "What observation period and clinical endpoints has the treating team selected for this exposure and renal context?", "kind": "action", "id": "recurrence-surveillance-q01" }, { "text": "Have symptoms or electrical abnormalities recurred after initial improvement?", "kind": "measurement", "id": "recurrence-surveillance-q02" } ] } ] }, { "id": "future-exposure-control", "name": "Future exposure control", "description": "Link episode closure to correction of the precipitating circumstances.", "findings": [ { "id": "precipitant-correction-and-regimen-review", "name": "Precipitant correction and regimen review", "description": "Record how the identified cause was addressed and who owns any subsequent digoxin decision.", "questions": [ { "text": "What verified changes address the implicated dosing error, interaction or change in clearance?", "kind": "action", "id": "precipitant-correction-and-regimen-review-q01" }, { "text": "Who will reassess the ongoing digoxin indication, any restart and follow-up monitoring?", "kind": "action", "id": "precipitant-correction-and-regimen-review-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "This is a clinical toxicological condition, despite the batch context discussing abstract concepts.", "Diagnosis requires clinical assessment; neither an isolated serum concentration nor a characteristic ECG appearance is sufficient.", "Exact coding, treatment thresholds and current regional guidance require verification; no sources were consulted for this recall description." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of digoxin toxicity this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Acute toxicity following overdose", "Chronic toxicity during ongoing therapy", "Acute-on-chronic toxicity" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of digoxin toxicity this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Recognised in emergency medicine, clinical toxicology and cardiology when evaluating arrhythmias or compatible systemic symptoms in someone exposed to digoxin.", "Distinguishing acute from chronic toxicity informs interpretation of serum digoxin and potassium measurements.", "Recognition guides withdrawal of digoxin, cardiac monitoring, correction of contributing factors and consideration of digoxin-specific antibody fragments." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of digoxin toxicity this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "quantity": "Serum digoxin concentration", "typical_range": "No concentration alone establishes or excludes toxicity; interpretation depends on symptoms, sampling time, kidney function and treatment with digoxin-specific antibody fragments.", "unit": "ng/mL" }, { "quantity": "Serum potassium concentration", "typical_range": "Variable: hyperkalaemia can accompany severe acute poisoning, while hypokalaemia increases susceptibility to toxicity.", "unit": "mmol/L" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of digoxin toxicity this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Potentially fatal arrhythmias, including atrioventricular block, marked bradycardia and ventricular arrhythmias.", "Gastrointestinal, neurological and visual symptoms may be nonspecific and delay recognition.", "Reduced renal clearance and interacting medicines can cause accumulation during prescribed treatment.", "Electrolyte disturbances, particularly hypokalaemia and hypomagnesaemia, can increase susceptibility.", "Premature sampling after a dose and routine digoxin assays after antibody-fragment treatment can produce misleading interpretations." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of digoxin toxicity this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Availability of digoxin-specific antibody fragments and specialist poison-centre support varies between health systems." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of digoxin toxicity this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Digoxin exposure or overdose", "difference": "Exposure or an excessive dose describes what was taken; toxicity describes the resulting harmful clinical effects." }, { "name": "Digitalis or cardiac glycoside poisoning", "difference": "This broader category includes toxicity from related glycosides and plant sources; digoxin toxicity specifically involves digoxin." }, { "name": "Therapeutic digoxin effect", "difference": "Expected pharmacological effects, including characteristic ECG changes, do not by themselves establish toxicity." }, { "name": "Digoxin", "difference": "Digoxin is the drug substance; digoxin toxicity is a condition resulting from its harmful effects." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "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?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "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?" ], "statistics": { "bundles": 7, "layers": 13, "findings": 19, "questions": 31 } }