LAUSR

An 87-year-old male patient presented 3 hours after accidentally ingesting an unknown amount of digoxin in drops. Initial symptoms were vomiting, abdominal pain, precordial pain radiating to the back associated with dyspnea, and also intense heartburn. For these reasons, he consulted a doctor. On admission, the patient had a blood pressure of 156/60, heart rate of 40, breathing frequency of 18, and SatO2 of 95% to the environment. On physical examination, he had rhythmic heart sounds, bradycardia, abdomen with painful palpation in the epigastrium, and coldness in extremities. Paraclinical investigation revealed mild hyperkalemia, arterial gases with hyperlactatemia, respiratory alkalosis, digital cage EKG, grade III and prolonged QTc atrioventricular block, and digoxin levels at 18.78 ng/mL (taken 4 hours after ingestion, Table 1). By calculating the remaining dose of the bottle, the dose ingested was found to be approximately 3 mg of digoxin; the presentation is from a dropper bottle of 6 mg/10 mL. The patient has a personal pathological history of hypertension, diabetes mellitus type 2, ischemic heart failure with LVEF of 25%, dyslipidemia, hypothyroidism, osteoarthrosis, DVT anticoagulated with apixaban, chronic pain by narrow medullary canal + diabetic neuropathy, and incipient demential syndrome. The patient was treated ambulatory with beta-methyl digoxin 7 drops every 24 hours, carvedilol, spironolactone, furosemide, losartan, levothyroxine, esomeprazole, glargine, metformin/ sitagliptin, acetaminophen/hydrocodone, apixaban, and a buprenorphine patch.