Clinical aspects of digital intoxication at geriatric patients

Introduction: One of the most precious drugs is the digital added to the cardiovascular diseases therapeuics by scottish physician William Withering. Being an agent with a very low therapeutic index, the toxic doses are close to the curative ones, thus confronting the clinical aspects of digoxin toxicity.
Case presentation: We present the case of a 72 years old man, hypertensive (BPmax=280 mmHg), coronary, dyslipidemic, diabetic (under intermittent treatment with biguanides), diagnosed with atrial fibrillation at an outpatient evaluation about 30 days ago, reason for which treatment with Digoxin 0.25 mg/day was ini-tiated, admitted to emergency with non-specific digestive symptoms, headaches, palpitations, marked physical asthenia. Electrocardiographic monitoring re-vealed the appearance of digital impregnation on the background of sinus bradycardia with first-degree atrioventricular block and intermittent sinoatrial block. Bioumoral is objectified in the presence of nitrogen retention syndrome and dyselectrolytemia (hyponatremia, hypokalemia, hypochloremia). Echocardiography quantified severe left ventricular systolic dysfunction (EF=30%) and diastolic dysfunction and the severity of aortic valve lesions, mainly severe aortic stenosis. Under sustained treatment, significant improvement in complex pathology was achieved.
Conclusions: Digitalis intoxication diagnosis is sup-ported by chronic treatment with digoxin in conjunction with the appearance of clinical and ECG changes. Current guidelines recommend the use of digoxin in patients with low ejection fraction with frequent monitoring of geriatric population for dose adjustment, due to alterations in pharmacokinetics and pharmaco-dynamics properties of secondary medication to aging. It would be welcome in the medical market the launch of digoxin tablets dosed at 0,125 mg/tablet.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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