Digoxin toxicity

Case history #1

An 86-year-old woman presents with confusion and vomiting. She complains of weakness, nausea, and decreased appetite. Her history is significant for congestive heart failure for which she takes, among other medications, digoxin. In the hospital, she is alert and oriented in person, but not in time or place. Vital signs are normal except for a heart rate of 56 bpm. Her physical examination demonstrates bibasal crepitations, irregular S1, S2 with an S3 gallop, and bilateral lower extremity 2+ pitting oedema up to her shins.

Case history #2

A 19-year-old woman presents approximately 30 minutes after ingesting 30 of her grandmother's 250 micrograms digoxin tablets in a suicide attempt. In the hospital, her vital signs are normal. She is in no acute distress and has no complaints; physical examination is within expected limits. About 30 minutes after arrival, she complains of non-specific abdominal pain and starts vomiting.

Other presentations