Which symptom list could indicate digoxin toxicity if observed in a patient on digoxin?

• A. Dry mouth, convulsion, and coma.
• B. Muscle cramps.
• C. Nausea, diarrhea, pulse below 60.
• D. Increased perspiration and very fast pulse.

Answer: (C)

Digoxin toxicity tends to show up with a combination of gastrointestinal symptoms and changes in heart rate due to impaired electrical conduction in the heart. Nausea and diarrhea are common early signs, and a slowed pulse reflects the drug’s effect on the AV node and overall conduction when levels are high. When digoxin reaches toxic levels, the combination of GI upset and bradycardia is a classic warning signal that the heart is being overly affected. The other patterns—dry mouth with convulsions or coma, isolated muscle cramps, or sweating with a very fast pulse—don’t align as closely with the typical digoxin-toxic presentation, which is why the symptom set with nausea/diarrhea and a slowed heart rate best indicates toxicity.