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<< Emergency Department Management Of Calcium-Channel Blocker, Beta Blocker, And Digoxin Toxicity

Diagnostic Studies

Patients with a suspected cardiotoxic overdose require a complete blood count, chemistry with extended electrolytes (calcium, magnesium, phosphate), glucose, coagulation studies, lactate, and a digoxin level. Lactate levels are not routinely elevated with ingestion of these agents, and they are not useful as an initial screen of severity (as over half of patients will have an initial lactate level < 3 mmol/L39), but they may serve a role in differentiating other mechanisms of shock. Obtain serum salicylate, acetaminophen, osmolality, and ethanol levels, especially in patients with any alteration in mental status,40 as well as betahCG in female patients.

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