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Digoxin toxicity in an older patient with acute kidney injury — SCE Acute Medicine MCQ

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HardMedicine in the elderlyDigoxin toxicity in an older patient with acute kidney injurySCE Acute Medicine

An 84-year-old woman with atrial fibrillation and heart failure presents with nausea, visual disturbance and confusion after a course of clarithromycin for pneumonia. ECG shows atrial fibrillation at 48/min with scooped ST segments; potassium is 3.1 mmol/L and creatinine has risen to 168 micromol/L. Her drug chart includes digoxin. What is the most likely underlying cause?

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Correct answer: A — Digoxin toxicity precipitated by renal impairment, hypokalaemia and macrolide interaction

Digoxin toxicity is promoted by renal impairment, hypokalaemia and interacting drugs such as macrolides, and causes gastrointestinal, visual, neurological and bradyarrhythmic features. Hyperthyroidism would usually accelerate AF rather than cause slow ventricular response. The key management is stopping digoxin, correcting potassium carefully and considering digoxin-specific antibody fragments if severe.

Reference: BNF digoxin; NICE CKS atrial fibrillation