Which of the following is a classic sign of digoxin toxicity?

• A. Nausea
• B. Hypertension
• C. Tremor
• D. Rash

Answer: (A)

Nausea signals gastrointestinal involvement from digoxin toxicity. Digoxin works by inhibiting the Na+/K+-ATPase pump to increase intracellular calcium and boost heart muscle contraction, but this same disruption can irritate the GI tract, leading to early symptoms like nausea (and sometimes vomiting or anorexia). Recognizing nausea as an early and classic sign helps prompt evaluation before more dangerous effects, such as arrhythmias or CNS changes, develop. Hypertension is not typically associated with digoxin toxicity; in fact, digoxin toxicity more often presents with bradycardia or various conduction abnormalities. Tremor and rash are not characteristic signs of digoxin toxicity. If toxicity is suspected, monitor heart rate and rhythm, check digoxin level and potassium, and notify the clinician for further management.