Elderly female with CHF complains of abdominal pain, nausea and vomiting, dizziness, and confusion for 5 days. What is the cause?

Author: V. Dimov, M.D.Reviewer: S. Randhawa, M.D.A 96-year-old African American female (AAF) was admitted from a nursing home with complaints of abdominal pain, nausea and vomiting (N/V), dizziness, confusion and double vision for 5 days. She was discharged from the hospital just 4 days ago. Digoxin was started during that previous hospitalization for control of tachycardia in atrial fibrillation. One day prior to discharge, digoxin level was 1.8 mg/mL and digoxin dose was decreased to 125 mcg PO Q 48 hr.Past medical history (PMH)Hypertension, atrial fibrillation, coronary artery disease, stroke, congestive heart failure.MedicationsMetoprolol, digoxin, ASA (aspirin), lisinopril, furosemide (Lasix), Coumadin (warfarin), esomeprazole (Nexium).Physical examinationIn pain, combative and confused.VSS.Chest: Occasional bibasilar crackles.Cardiovascular System: Clear S1 and S2, irregularly irregular rhythm, HR 101 bpm.Abdomen: Soft, epigastric tenderness, no rebound, + BS.Extremities: No edema.What is the most likely diagnosis?What would you do?Click here for theanswer and final diagnosis in this case.Published: 08/02/2009Updated: 08/02/2009
Source: Clinical Cases and Images - Category: General Medicine Tags: Cardiology Intensive Care Toxicology Source Type: news