Digoxin
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Xanthopsia and other toxicities: case report A 76-year-old man developed xanthopsia, atrial fibrillation and ST segment depression secondary to digoxin toxicity during treatment with digoxin for heart failure [not all outcomes stated]. The man was admitted due to bilateral leg oedema and dyspnoea. He was diagnosed with heart failure 3 months prior and treated with unspecified diuretics resulting in improvement; however, the symptoms recurred. Therefore, he was initiated on digoxin 0.125 mg/day, which was later increased to 0.25 mg/day [route not stated], but the symptoms remained persistent. His medical history was significant for dementia, hypertension and benign prostatic hyperplasia. At presentation, he had been receiving digoxin, furosemide and spironolactone. He reported to have quit smoking 20 years prior and alcohol 1 year prior. An ECG findings were significant for atrial fibrillation and ST-segment depressions in leads I, II, aVF, and V3 to V6. Further chest X-ray indicated pulmonary congestion and mild bilateral pleural effusion. Laboratory findings showed the following: estimated GFR 33.5 mL/min/1.73 m2 , creatinine 1.6 mg/dL, brain natriuretic peptide 681.1 pg/mL and serum digoxin 7.3 ng/mL. Based on these findings, he was diagnosed with digoxin toxicity. Anamnesis revealed that he had developed xanthopsia several days prior to admission. He reported to have experienced two traffic accidents over one week prior to admission on a familiar road. Eye examinations showed corrected visual acuities of 6/20 and 6/60 in the right and left eye, respectively. In addition, decreased responses on flash, cone and a 30Hz flicker electroretinograms were found in both eyes. Xanthopsia was considered to have developed secondary to digoxin toxicity. The man’s treatment with digoxin was discontinued, and he received IV hydration. Additionally, he received unspecified catecholamines for bradycardia. The symptoms of xanthopsia and heart failure improved and disappeared within 1 week. His clinical course was further complicated by delirium and aspiration pneumonia [aetiologies not stated]. Electroretinography findings were normalised 1 month following admission. Haruna Y, et al. Xanthopsia due to digoxin toxicity as a cause of traffic accidents: A case report. American Journal of Case Reports 21: 08 Aug 2020. Available from: URL: 803504879 https://www.amjcaserep.com/download/index/idArt/924025
0114-9954/20/1824-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 3 Oct 2020 No. 1824
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