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Digoxin toxicity — DGM MCQ

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HardPolypharmacyDigoxin toxicityDGM

An 82-year-old woman presents with nausea, confusion and yellow-green visual disturbance. She has atrial fibrillation and chronic kidney disease. Pulse is 48 beats/min and potassium is 5.8 mmol/L. Current medicines include digoxin, furosemide and ramipril. What is the most likely diagnosis?

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Correct answer: D — Digoxin toxicity

Nausea, visual disturbance, bradycardia and renal impairment in a patient taking digoxin suggest digoxin toxicity. Vestibular neuritis and migraine do not explain bradycardia and hyperkalaemia, gastroenteritis alone is insufficient, and Alzheimer's disease is not acute. Renal decline can turn a previously stable digoxin dose into toxicity.

Reference: BNF; STOPP/START criteria v3