Digoxin Toxicity

20-year-old female presented to ER with alleged history of ingestion of Tab.Digoxin (unknown quantity).  She presented to ER to with symptoms of uneasiness, generalized unwell, nausea, vomiting. Her vitals are as follows.

• GCS – E2 V2 M3
• HR -  86 per min
• BP – 84 / 45 mmHg
• Spo2 – Not recordable
• Delayed capillary refill
• Peripheries – Cold & clammy
• ECG done as follows
• serum digoxin level – Awaited
• Urea – 69 mg/dl
• Creatinine – 1.9 mg/dl
• Na – 140 mEq/L
• K – 6.5 mEq/L
• Echo suggestive of Biventricular dysfunction