طفل عمره ٤ سنوات عنده عيب قلبي وفشل قلب، يأخذ ديجوكسين وفوروسيمايد. أمه تقول إنه يستفرغ منذ يوم، ولا يريد الأكل، وصار خاملاً. النبض ٦٨، وهو أبطأ من المعتاد. ماذا يشك الممرض؟

A 4-year-old with congenital heart disease and heart failure takes digoxin and furosemide. His mother says he has vomited for a day, refuses food and is lethargic. HR 68, slower than usual. What does the nurse suspect?

1. Improving heart failure
2. Teething
3. Milk allergy
4. Digoxin toxicity

Answer: D) Digoxin toxicity. In children, vomiting, anorexia, nausea and bradycardia are early signs of digoxin toxicity. Pulse, drug level and potassium are checked and the prescriber told before the next dose.