Learning Point for Clinicians

In patients with chronic digoxin toxicity, espe-cially in the presence of renal impairment, a prolonged duration of continuous monitoring is required with consideration given to further doses of immune fab if necessary for re-emergence of toxicity. Case presentation A 68-year-old lady presented with one weeks ’ his-tory of nausea, vomiting and generalized malaise. She had been diagnosed recently with atrial fibrilla-tion (AF) and commenced on oral digoxin at 250 mg daily. Her past medical history included chronic kidney disease. On admission, her pulse rate was 40 beats per minute (BPM) and a blood pressure of 102/66