A distinct clinical presentation exists for both acute and chronic digitalis glycoside toxicity ( Table 16.8.-1). Acute poisoning most often results from accidental or intentional ingestion. There may be an asymptomatic period of several hours prior to development of symptoms. Gastrointestinal symptoms are often the earliest manifestation of toxicity. In the early period of toxicity, increased central vagal tone produces cardiac dysrhythmias that are typically bradydysrhythmias, or supraventricular dysrhythmias with AV block; however, life-threatening ventricular dysrhythmias may develop at any stage in an acute massive ingestion. 6 Acute toxicity most closely correlates with hyperkalemia, and correlates poorly with the serum digoxin level. 9
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