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Digoxin toxicity — DGM MCQ

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HardPolypharmacyDigoxin toxicityDGM

An 87-year-old woman with atrial fibrillation presents with nausea, anorexia and yellow-green visual disturbance. Pulse is 46/min and potassium is 3.0 mmol/L after increased furosemide. Her medicines include digoxin, furosemide, ramipril and warfarin. What is the most likely diagnosis?

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Correct answer: B — Digoxin toxicity

Bradycardia, nausea, visual disturbance and hypokalaemia in a patient taking digoxin are highly suggestive of digoxin toxicity. Stroke may cause visual symptoms but would not explain the gastrointestinal features, bradycardia and hypokalaemia pattern. Older adults are vulnerable to digoxin toxicity during renal or electrolyte changes.

Reference: BNF; NICE CKS Atrial fibrillation