TY - JOUR
T1 - Digoxin toxicity with normal digoxin and serum potassium levels
T2 - Beware of magnesium, the hidden malefactor
AU - Raja Rao, Mamatha Punjee
AU - Panduranga, Prashanth
AU - Sulaiman, Kadhim
AU - Al-Jufaili, Mahmood
PY - 2013/8
Y1 - 2013/8
N2 - Background: In recent years, digoxin use has been on the decline, with decreased incidence of digoxin toxicity. Hence, digoxin toxicity, when it occurs, remains an elusive diagnosis to emergency physicians. Objective: To present a case of digoxin toxicity with normal levels of digoxin and serum potassium, but with severe hypomagnesemia. Case Report: A 66-year-old woman presented with junctional tachycardia and ectopic atrial tachycardia. She was known to have congestive cardiac failure on diuretic therapy. Her serum digoxin level was within the normal range (2.4 nmol/L [normal = 1.9-2.6]) along with a normal serum potassium level (3.9 mmol/L [normal = 3.5-5]). However, there was severe hypomagnesemia (0.39 mmol/L [normal = 0.65-1.25]) precipitating digoxin-induced dysrhythmia, which responded well to intravenous magnesium therapy. Conclusion: This case reiterates that digoxin toxicity can occur in patients with normal digoxin and potassium levels, and in such patients, magnesium needs to be checked and treated to prevent potentially life-threatening dysrhythmias.
AB - Background: In recent years, digoxin use has been on the decline, with decreased incidence of digoxin toxicity. Hence, digoxin toxicity, when it occurs, remains an elusive diagnosis to emergency physicians. Objective: To present a case of digoxin toxicity with normal levels of digoxin and serum potassium, but with severe hypomagnesemia. Case Report: A 66-year-old woman presented with junctional tachycardia and ectopic atrial tachycardia. She was known to have congestive cardiac failure on diuretic therapy. Her serum digoxin level was within the normal range (2.4 nmol/L [normal = 1.9-2.6]) along with a normal serum potassium level (3.9 mmol/L [normal = 3.5-5]). However, there was severe hypomagnesemia (0.39 mmol/L [normal = 0.65-1.25]) precipitating digoxin-induced dysrhythmia, which responded well to intravenous magnesium therapy. Conclusion: This case reiterates that digoxin toxicity can occur in patients with normal digoxin and potassium levels, and in such patients, magnesium needs to be checked and treated to prevent potentially life-threatening dysrhythmias.
KW - digoxin toxicity
KW - dysrhythmia
KW - hypokalemia
KW - hypomagnesemia
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U2 - 10.1016/j.jemermed.2012.11.111
DO - 10.1016/j.jemermed.2012.11.111
M3 - Article
C2 - 23685098
AN - SCOPUS:84881153898
SN - 0736-4679
VL - 45
SP - e31-e34
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 2
ER -