![]() Past medical history: hypertension, hypothyroidism, prior cholecystectomy.No known drug allergies.Medications: HCTZ 25 mg daily, diltiazem CD 120 mg daily, and levothyroxine 88 mcg daily. Symptoms started 3 days ago and progressively worsened. EKG: complete AV dissociation present.Ī 43-year-old Caucasian woman, previously in good health, presented to the emergency department with headache, blurred vision, and dizziness. Laboratory workup: potassium 5.8 mEq/L, BUN 40 mg/dL, creatinine 4.2 mg/dL, digoxin level 4.8 ng/mL (reference range: 0.5-2.0 ng/mL). Lungs fields clear without rales, rhonchi, or wheezes. ![]() ![]() ![]() Normal S1 and S2 without obvious rub, murmur, or gallop. Vitals: temp 98.8☏, pulse 40 bpm slightly irregular, respirations 16/min, blood pressure 108/60 mm Hg. Yellow/green halos around lights for 3 days. Decreased appetite for 3 days with fatigue and malaise. Medications: furosemide, digoxin, enalapril, carvedilol, tamsulosin. He denies drug allergies but reports blood pressure was low with diltiazem. PMH is significant for congestive heart failure secondary to non-ischemic cardiomyopathy, atrial fibrillation, hypertension, chronic renal insufficiency (with baseline creatinine 2.0), and BPH. 7 days ago, he experienced significant diarrhea for 4 days, with progressively worsening nausea and vomiting since. A 57-year-old man presents to the ED with syncopal spell 1 hour ago.
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