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Digoxin Toxicity CKD — ESENeph MCQ

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EasyChronic Kidney DiseaseDigoxin Toxicity CKDESENeph

A 70-year-old man with CKD G4 (eGFR 20) is prescribed Digoxin 125 mcg daily for atrial fibrillation with fast ventricular rate. After 2 weeks he develops nausea, yellow-tinged vision, and bradycardia (HR 42). What has occurred?

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Correct answer: D — Digoxin toxicity from accumulation in CKD – Digoxin is renally cleared and requires dose reduction and level monitoring in CKD

Digoxin is predominantly renally excreted (60-75%). In CKD G4, the half-life extends from 36 hours to >100 hours, causing significant accumulation at standard doses. Classic toxicity features include GI symptoms (nausea, anorexia), visual disturbance (xanthopsia – yellow vision), and cardiac effects (bradycardia, heart block, ventricular arrhythmias). BNF recommends reduced doses (62.5-125 mcg alternate days or less) in CKD with therapeutic drug monitoring (target 0.5-1.0 ng/mL). Hypokalaemia and hypercalcaemia potentiate toxicity.

Reference: BNF 2024 – Digoxin; NICE NG196 – AF