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Digoxin toxicity with hypokalaemia — SCE Acute Medicine MCQ

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HardMedicine in the ElderlyDigoxin toxicity with hypokalaemiaSCE Acute Medicine

An 88-year-old man with atrial fibrillation and chronic kidney disease is brought in with nausea, confusion and yellow visual halos. He takes digoxin 250 micrograms daily and furosemide. ECG shows scooped ST depression with frequent ventricular ectopics, potassium is 3.1 mmol/L and digoxin level is elevated. What is the most likely underlying cause of his presentation?

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Correct answer: D — Digoxin toxicity precipitated by renal impairment and hypokalaemia

Confusion, visual disturbance, gastrointestinal symptoms, ectopy and elevated level indicate digoxin toxicity, worsened by CKD and hypokalaemia. Scooped ST segments can be a digoxin effect, but the symptoms and arrhythmia indicate toxicity. MI remains a consideration but does not explain halos and high digoxin level. The pearl is that low potassium increases myocardial sensitivity to digoxin.

Reference: BNF, TOXBASE digoxin poisoning