Reactions 1476, p15 - 2 Nov 2013

SDigoxin

Digoxin toxicity in an elderly patient: case reportA 65-year-old woman developed digoxin toxicity, with visual

symptoms, vomiting and complete heart block, whilereceiving digoxin.

The woman presented with a 3-day history of recurrentvomiting, which had persisted despite treatment withantiemetics. She had previously been diagnosed with an atrialseptal defect, and was receiving diuretics and digoxin [dosage,route and duration of treatment to reaction onset not stated]for paroxysmal supraventricular tachycardia. Uponpresentation, she had bradycardia, as well as the cardiacsymptom of severe fatigue. Examination revealed centralcyanosis and clubbing. She was admitted to a cardiac care unit,where she reported that the ambient lighting was hurting hereyes. A detailed history revealed that she had had photophobiafor 1 month before admission, and it was severe enough toconfine her to her home. Another initially unreported visualsymptom was that she reported seeing ’little yellow men’,which was how she perceived the attending doctors, thus thiswas probably a form of visual hallucination. An ECG showedcomplete heart block with ST-segment changes, which weresuggestive of digitalis toxicity. Echocardiography confirmedthe presence of a large ostium secundum atrial septal defect,with bidirectional shunting, severe pulmonary arterialhypertension and a dilated right atrium and ventricle,consistent with Eisenmengerisation. Her serum digoxin levelwas elevated at 3.63 ng/mL. Colour vision evaluation revealedbilateral red-green deficits.

Digoxin was withdrawn, while diuretics were continued.Within 72 hours, the woman reverted to sinus rhythm, andover the following week, she reported a subjectiveimprovement of visual symptoms. She was later discharged.

Author comment: "This case thus highlights the visualsymptoms of digoxin toxicity and demonstrates the degree towhich they can impact a patient’s life."Naha K, et al. Of little yellow men and a fear of the light. BMJ Case Reports2013: [3 pages], 13 Aug 2013. Available from: URL: http://dx.doi.org/10.1136/bcr-2013-200339 - India 803094915

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Reactions 2 Nov 2013 No. 14760114-9954/13/1476-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved