Q: 54 year old patient with CHF presented to ER with dizzyness. Patient is found to be in 3rd degree AV block. Digoxin level is 4.2 nmol/l. You decide to adminster Digibind. 12 hours later nurse call you with potassium level of 2.8 mEq/L?


Answer: With administration of DigiFab (Digibind), serum potassium concentration should be followed very closely. Digibind shifts potassium back into the cell and life threatening hypokalemia may develop rapidly.

Actually, Digoxin causes a shift of potassium from inside to outside of the cell, may causing a life-threatening hyperkalemia despite whole body deficit of potassium. With administration of Digifab, actual hypokalemia may manifest which could be equally life threatening.