Learn about high serum digoxin level diagnosis, including causes, symptoms, treatment, and ICD-10-CM code R79.89. This resource provides information on digoxin toxicity, therapeutic drug monitoring, and clinical documentation best practices for healthcare professionals. Find details on digoxin level interpretation, adverse drug reactions, and patient education regarding digoxin medication management.
Also known as
Poisoning by cardiac glycosides
Adverse effect of digoxin, high level.
Other specified abnormal findings
Includes abnormal levels of drugs like digoxin.
Poisoning by drugs, medicaments
Adverse effect of unspecified drug, includes digoxin.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the high digoxin level due to accidental overdose?
Yes
Is there poisoning by digoxin?
No
Is there intentional overdose of digoxin?
When to use each related code
| Description |
|---|
| High digoxin level |
| Digoxin toxicity |
| Digoxin overdose |
Using unspecified digoxin codes when a more specific code for high serum digoxin level is available (e.g., R79.89). Impacts DRG and reimbursement.
Failing to code digoxin toxicity (T46.0X5A) when clinically indicated, leading to underreporting of severity and potential quality issues.
Insufficient documentation to support the high serum digoxin level diagnosis, increasing risk of claim denials and compliance issues.
Q: What are the most common causes of high serum digoxin levels in patients with heart failure and how can I differentiate them clinically?
A: High serum digoxin levels in heart failure patients can stem from various factors, often interacting in complex ways. Decreased renal clearance is a primary culprit, especially in elderly patients or those with acute kidney injury. Drug interactions, specifically with amiodarone, verapamil, quinidine, and macrolide antibiotics, can significantly inhibit digoxin metabolism and contribute to elevated levels. Additionally, hypothyroidism, hypokalemia, and even myocardial infarction can impact digoxin pharmacokinetics. Differentiating these causes requires a thorough patient history, including medication review, assessment of renal function (e.g., estimated GFR), and electrolyte monitoring. Physical exam findings such as arrhythmias, gastrointestinal symptoms (nausea, vomiting), and neurological changes can suggest digoxin toxicity but are non-specific. Therefore, careful consideration of the clinical context in conjunction with serum digoxin level interpretation is crucial for accurate diagnosis and management. Consider implementing a standardized protocol for digoxin monitoring and management in your practice. Explore how integrated electronic health record systems can facilitate such protocols and improve patient safety.
Q: How do I interpret a high digoxin level in a patient with atrial fibrillation who is also on amiodarone? What specific management steps should I take?
A: Interpreting high digoxin levels in patients with atrial fibrillation on amiodarone requires a nuanced approach. Amiodarone significantly inhibits digoxin metabolism, frequently leading to elevated serum digoxin concentrations even with standard dosing. It is crucial to consider the timing of amiodarone initiation relative to the digoxin measurement. Typically, digoxin levels will rise within the first 1-2 weeks of starting amiodarone and stabilize thereafter. In such cases, simply reducing the digoxin dose by 50% and closely monitoring serum levels, as well as clinical signs and symptoms, is usually sufficient. However, if the patient presents with signs or symptoms of digoxin toxicity (e.g., severe bradycardia, visual disturbances, nausea, vomiting), temporary digoxin discontinuation and supportive care are warranted. Electrolyte imbalances, particularly hypokalemia, should also be addressed promptly. Learn more about evidence-based guidelines for managing digoxin and amiodarone co-administration.
Patient presents with signs and symptoms suggestive of digoxin toxicity, including nausea, vomiting, anorexia, and visual disturbances described as yellow-green halos. Patient reports compliance with prescribed digoxin regimen. Laboratory results confirm elevated digoxin serum levels exceeding the therapeutic range. Differential diagnoses considered include acute coronary syndrome, electrolyte imbalances, and other drug interactions. ECG findings demonstrate characteristic changes associated with digoxin toxicity, such as prolonged PR interval and ST-segment depression. Current medications reviewed for potential drug-drug interactions contributing to high digoxin levels. Assessment points toward digoxin toxicity as the primary diagnosis based on clinical presentation, laboratory data, and ECG findings. Plan includes immediate discontinuation of digoxin, monitoring of serum digoxin levels, and initiation of digoxin-specific antibody fragments (Digibind) if clinically indicated. Patient education provided regarding signs and symptoms of digoxin toxicity, importance of medication compliance, and follow-up care. Electrolyte levels, including potassium and magnesium, will be monitored and corrected as needed. Cardiac monitoring will continue to assess for arrhythmias. Diagnosis codes for digoxin toxicity and related complications will be documented for medical billing and coding purposes. The patient's response to treatment will be closely monitored and documented in the electronic health record.