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Digoxin toxicity in renal impairment — SCE Acute Medicine MCQ

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HardMedicine in the ElderlyDigoxin toxicity in renal impairmentSCE Acute Medicine

An 87-year-old woman with atrial fibrillation presents with nausea, yellow-green visual disturbance and falls. She takes digoxin and furosemide. ECG shows slow atrial fibrillation with ventricular rate 42/min, potassium is 5.8 mmol/L and creatinine is 184 micromol/L. What is the most likely diagnosis?

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Correct answer: A — Digoxin toxicity precipitated by renal impairment

GI symptoms, visual disturbance, bradyarrhythmia, hyperkalaemia and renal impairment in a patient taking digoxin indicate digoxin toxicity. Slow AF is a classic ECG clue. Acute glaucoma could cause visual symptoms but would not explain bradyarrhythmia and hyperkalaemia. The pearl is that acute kidney injury can turn a stable chronic digoxin dose toxic.

Reference: BNF digoxin; TOXBASE