Digoxin Toxicity and Acute Renal Failure in a 75 Year-Old Female

Digoxin toxicity can present with varying manifestations. While pathognomonic symptoms such as xanthopsia (object appearing yellow) are a board favorite it is not a required finding and is in fact not seen with most patients. Rather digoxin toxicity presents with more non-specific symptoms such as GI distress (anorexia, N/V) neurological distress (lethargy, fatigue, delirium, confusion, disorientation, weakness. EKG findings are varied and include premature ventricular contractions, bradycardia, atrial tachyarrhythmias with AV block, ventricular bigeminy, junctional rhythms, various degrees of AV nodal blockade, ventricular tachycardia, and ventricular fibrillation. Although rarely seen, digoxin is one of the only causes of bidirectional ventricular tachycardia. Digoxin levels should be ordered when a patient presents with any of the above symptoms, especially if they have a history or renal disease. In the following case the patient had only recently began taking digoxin a couple weeks prior for new onset a fib and had a history of chronic kidney disease secondary to polycystic kidney disease with bilateral renal transplants 12 years prior