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Abstract:
Case histories of four elderly patients with central nervous system signs of digitalis toxicity were reviewed. Evidence of toxicity included lethargy, depression which was not present previously, confusion, restlessness, emotional instability, hyperventilation, and vertigo. Vomiting developed four days after the onset of the mental changes. No cardiac arrhythmias were observed. Digoxin serum levels ranged between 4.2 and 7.0 ng/ml. Serum potassium values were within normal limits. Three of the four patients recovered with a return of their mental status to the pretoxic state. The fourth case was fatal. At autopsy long-standing myocardial ischemia was the only significant finding.
Insights
Central nervous system signs of digitalis toxicity, including confusion and lethargy, were observed in elderly patients. Despite high digoxin levels, cardiac issues were absent, with most patients recovering.
Area of Science:
- Geriatric Medicine
- Clinical Toxicology
- Pharmacology
Background:
- Digitalis glycosides are commonly prescribed for heart conditions in the elderly.
- Digitalis toxicity can manifest with a range of symptoms, often including cardiac arrhythmias.
- Central nervous system (CNS) effects of digitalis toxicity are less commonly emphasized.
Observation:
- This case series reviewed four elderly patients presenting with CNS signs suggestive of digitalis toxicity.
- Reported symptoms included lethargy, new-onset depression, confusion, restlessness, emotional instability, hyperventilation, and vertigo.
- Vomiting occurred several days after the onset of neurological symptoms. Notably, no cardiac arrhythmias were detected in these patients.
Findings:
- Serum digoxin levels in the affected patients ranged from 4.2 to 7.0 ng/ml, indicating elevated levels.
- Serum potassium levels were within the normal range, ruling out hypokalemia as a contributing factor.
- Three out of four patients experienced a full recovery of their mental status after management, while one patient had a fatal outcome.
Implications:
- The findings highlight that CNS manifestations can be primary indicators of digitalis toxicity in the elderly, even without cardiac arrhythmias.
- Therapeutic drug monitoring and careful clinical assessment are crucial for managing digitalis toxicity in geriatric populations.
- Long-standing myocardial ischemia was the sole significant finding in the fatal case, suggesting potential underlying vulnerabilities.