Digoxin intoxication-induced encephalopathy in a patient with chronic kidney disease

Digoxin is a drug with a narrow therapeutic range. We present an 88-year-old woman with chronic kidney failure who was suspected of having digoxin intoxication when she developed nausea, vomiting, loss of appetite, lethargy, and unconsciousness after taking digoxin 0.25 mg daily for 1 week. A blood test revealed a high digoxin concentration of 5.42 ng/mL. The patient experienced bradycardia, hypotension, acute renal failure, and hyperkalemia. Electroencephalography revealed global brain dysfunction. She was given a temporary pacemaker and several rounds of dialysis. The digoxin concentration in the patient's blood was monitored every 2 days, and she gradually regained consciousness as the level of digoxin decreased to the normal range within 2 weeks. Patients with chronic renal failure should be monitored and tested before the administration of digoxin to titrate the dose. The drug plasma concentration should be carefully monitored for 5-7 days after drug administration. Patients' renal function, associated electrolyte concentrations, and drug levels should be tested regularly to ensure drug safety. Copyright (C) 2011, Buddhist Compassion Relief Tzu Chi Foundation. Published by Elsevier Taiwan LLC. All rights reserved.