Digoxin
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Digoxin toxicity in an elderly patient: case report A 71-year-old woman with dehydration from Clostridium difficile diarrhoea developed digoxin toxicity while receiving digoxin. The woman presented to a hospital with altered mental status, visual disturbance, nausea, vomiting and multiple episodes of diarrhoea. She had a history of hypertension and atrial fibrillation, which were controlled with digoxin [dosage, route and duration of treatment to reaction onset not stated] and metoprolol. She had recently received ciprofloxacin during knee arthroplasty. Tests revealed a digoxin concentration of 5.0 ng/mL, while ECG showed an ectopic atrial rhythm, with ST-T wave abnormalities, a prolonged PR interval and shortened QRS complex. The woman received fluids, metronidazole and vancomycin. Tests were positive for C. difficile toxin. Her digoxin concentration subsequently returned to normal, and her symptoms gradually dissipated. Her diarrhoea resolved by day 5 of admission. Author comment: "[P]atients presenting with [C. difficile] infections who are concomitantly on digitalis therapy are at higher risk of adverse effects." Sonpal N, et al. The difficile diarrhea digoxin disaster. American Journal of Gastroenterology 108 (Suppl. 1): S313 abstr. 1049, Oct 2013. Available from: 803096365 URL: http://dx.doi.org/10.1038/ajg.2013.267 - USA
0114-9954/13/1480-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Reactions 30 Nov 2013 No. 1480
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