Abstract
A case of digoxin toxicity occurring in a patient with stable renal function and serum digoxin levels of 0.6–0.9 ng/ml is discussed. The patient is a 62-year-old black male admitted to the hospital with a chief complaint of shortness of breath. The patient's problem list included: (1) congestive heart failure, (2) coronary artery disease, (3) adult-onset diabetes mellitus, (4) cerebral vascular accident, (5) fever, and (6) anemia. The patient complained of a poor appetite and “sour stomach” while on digoxin. Serum electrolytes were normal, and the serum creatinine was essentially stable with a range of 1.2–1.6 mg% reported. Despite the “apparent” therapeutic serum digoxin levels, a probable diagnosis of digoxin toxicity was made, and the patient responded within two days of the dechallenge with improvement in the nausea and anorexia. The limitations and problems in assessing digoxin toxicity with serum digoxin levels are discussed.
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