Iranian Heart Journal

Iranian Heart Journal

Predominant Neurological Manifestations of Severe Digoxin Toxicity in an Older Patient

Document Type : Case Report

Authors
Vania Chica Londoño
Sandra Isabel Suárez Velandia
Clinical Pharmacology Service, Marqués de Valdecilla University Hospital, Santander, Spain.
Abstract
An 81-year-old woman with a history of atrial fibrillation treated with digoxin was admitted for influenza A infection. During hospitalization, she developed progressive somnolence without focal neurological deficits. Initial evaluation, including brain imaging, showed no acute abnormalities. Laboratory studies revealed a markedly elevated serum digoxin concentration of 7.5 ng/mL, consistent with severe digoxin toxicity. Renal function was also closely monitored because of its potential contribution to impaired drug clearance. Electrocardiography showed atrial fibrillation without specific signs of digoxin toxicity. Digoxin therapy was immediately discontinued, and treatment with digoxin immune Fab was initiated. Following administration of the antidote, the patient exhibited rapid and complete neurological recovery over the subsequent 24 to 48 hours, with normalization of mental status. This case emphasizes the importance of maintaining a high index of suspicion for digoxin toxicity in older patients, particularly in the setting of acute infection or unexplained neurological deterioration during hospitalization. Early recognition and prompt antidotal therapy are essential. (Iranian Heart Journal 2026; 27(4): 87-90)
Keywords
digoxin toxicity
digoxin immune Fab
neurological manifestations
atrial fibrillation
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Iranian Heart Journal
Volume 27, Issue 4
Autumn 2026
Pages 87-90