A client with pulmonary edema has been on diuretic therapy. The client has an order for additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing that the client also will be started on digoxin (Lanoxin), a nurse checks the client’s most recent:
A. Digoxin level
B. Sodium level
C. Potassium level
D. Creatinine level
Correct Answer: C. Potassium level
The serum potassium level is measured in the client receiving digoxin and furosemide. Heightened digitalis effect leading to digoxin toxicity can occur in the client with hypokalemia. Hypokalemia also predisposes the client to ventricular dysrhythmias. Toxicity can also occur at lower levels, especially in the setting of other risk factors such as low body weight, advanced age, decreased renal function, and hypokalemia. Risk of hypokalemia increases with the use of a high dose of furosemide, decreased oral intake of potassium, in patients with hyperaldosteronism states (liver abnormalities or licorice ingestion) or concomitant use of corticosteroid, ACTH, and laxatives.
Option A: Digoxin has a narrow therapeutic index. The recommended serum levels stand between 0.8 to 2 ng/mL. When measuring a digoxin serum level, it is essential to draw blood at least 6 to 8 hours after the last dose. The toxicity increases as the serum drug levels increase above 2.0 ng/mL.
Option B: According to Beers Criteria, caution is necessary when administering diuretics to patients 65 years and older to avoid potential adverse effects of inducing hyponatremia by causing or exacerbating syndrome of inappropriate antidiuretic hormone secretion (SIADH); therefore, close monitoring of serum sodium is advisable at initiation or during the dose adjustment in older adults.
Option D: In patients with an advanced renal disease with fluid overload the patients should be closely monitored for oliguria, azotemia, and volume status; and if either oliguria or azotemia develops the furosemide should be discontinued to prevent kidney injury.
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