[Symptoms of severe digoxin intoxication in patients hospitalized in geriatric wards].

Digoxin is a drug commonly used in geriatrics. The purpose of the study is to present cases of elderly patients hospitalized on the Geriatric Ward of the Provincial Neuro-Psychiatric Hospital "Dziekanka" in Gniezno with extremely high level of digoxin in the blood serum. The study was based on the case history of patients hospitalized on the ward from July 1998 to June 2003. During that time 83 patients (age: 77.4 +/- 8.1 years old, 60 females and 23 males) were suspected to suffer from digoxin intoxication on the basis of their morbid states, and their digoxin level in serum was measured. Furthermore, medical documentation of four patients with extremely high digoxin level was profoundly analyzed. Such is regarded, the level which exceeds by 100% the upper limit of concentration believed to be therapeutic (2 ng/ml) which is 4 ng/ml. The paper also includes a profile of clinical conditions of the patients at the time of their admission to the ward. While analyzing the patients' states, careful attention was drawn to the symptoms that might be caused by digoxin intoxication (changes in the ECG, central nervous system and gastrointestinal tract disturbances). However, because of typical for geriatrics polypathology and not clear characteristic clinical symptoms of majority of pathological syndromes, even severe intoxication may turn out to be impossible to diagnose. In the paper, coexistence of risk factors predisposing to appearance of toxic symptoms such as kidney failure, hypoproteinemia, dehydration, hypoxia, electrolyte abnormalities, drug interactions, and a possibility of improper taking medication were pointed out. It was concluded that lack of specific signs of severe digoxin intoxication among the elderly results in the fact that every worsening in a patient's state of health of an unknown reason treated with digoxin should be suspected as digitalis' glycosides intoxication.