Digoxin Toxicity with Nonspecific Symptoms in an Elderly Dialysis Patient: A Diagnostic Challenge in the Emergency Department

Digoxin toxicity is often difficult to recognize in elderly patients with renal failure because symptoms are vague and frequently overlap with common acute conditions. We describe an 81-year-old woman on chronic haemodialysis who presented with progressive asthenia, psychomotor slowing, fever, and altered mental status, initially suggesting sepsis. Laboratory tests showed mild hyperkalemia and metabolic acidosis, while imaging and cultures revealed no acute findings. Incomplete medication history delayed suspicion, but markedly elevated serum digoxin levels (>5 ng/mL) confirmed toxicity. Administration of digoxin-specific antibody fragments followed by haemodialysis led to progressive clinical improvement. This case highlights the need to consider digoxin toxicity in high-risk patients with nonspecific symptoms and emphasizes the importance of early recognition and antidote therapy to prevent severe complications.