All of the following increases the risk of Digoxin toxicity except
**Core Concept**
Digoxin toxicity is a significant concern in patients treated with this cardiac glycoside. It can lead to serious cardiac arrhythmias and other complications. The risk factors for digoxin toxicity are crucial for healthcare providers to identify and manage effectively.
**Why the Correct Answer is Right**
Digoxin is primarily excreted by the kidneys, and its clearance is reduced in patients with renal impairment. As a result, the risk of digoxin toxicity increases in patients with kidney disease, as they accumulate higher levels of the drug. This is because digoxin is not adequately cleared from the body, leading to elevated serum concentrations that can cause toxicity.
**Why Each Wrong Option is Incorrect**
**Option A:** Hypokalemia is a well-known risk factor for digoxin toxicity. It increases the sensitivity of the heart to digoxin and can lead to life-threatening arrhythmias. **Option B:** Elderly patients are more susceptible to digoxin toxicity due to age-related changes in renal function and decreased clearance of the drug. **Option C:** Hyperthyroidism can increase the risk of digoxin toxicity by increasing the sensitivity of the heart to digoxin and also due to increased metabolic rate which may lead to increased clearance of digoxin from the body.
**Clinical Pearl / High-Yield Fact**
The "5 Ks" are a useful mnemonic to remember the risk factors for digoxin toxicity: **Kidney disease**, **K+ (potassium) deficiency**, **Ketoacidosis**, **K+ supplements**, and **Age**.
**Correct Answer: D.**