Case 1 · Cardiology · digoxin
DD-01An 82-year-old woman taking digoxin 125 micrograms daily for atrial fibrillation develops vomiting, yellow-green visual disturbance and increasing confusion after three days of diarrhoea. She is bradycardic at 38/min. Creatinine has risen from 78 to 186 micromol/L. A digoxin concentration drawn two hours after her morning dose is reported as 1.7 micrograms/L (laboratory therapeutic interval 0.7–2.0). ECG shows atrial fibrillation with a slow ventricular response and frequent ventricular ectopics.
| Investigation | Result | Reference / context |
|---|---|---|
| Digoxin sample | 1.7 micrograms/L | Drawn 2 hours post-dose |
| Potassium | 5.8 mmol/L | 3.5–5.0 |
| Magnesium | 0.61 mmol/L | 0.7–1.0 |
| Creatinine | 186 micromol/L | Baseline 78 |
| ECG | AF 38/min + ventricular ectopy | New |