The daughter of an 82-year-old woman consults us because she has found her mother more confused than usual. The patient is diagnosed with moderate Alzheimer's disease. She also has AF, depression and osteoarthritis. She has been receiving stable treatment for 3 years, including digoxin, acenocoumarol, fluoxetine for the last 4 months and ibuprofen for the last month for joint pain. On examination, her blood pressure is 130/80, heart rate 48 bpm and respiratory rate 10 rpm. Which of the following is the most likely cause of the increased confusion?
The most likely cause is a digitalis intoxication, which would produce this slowing of conduction, which is seen in the heart rate. Probably secondary to renal failure due to ibuprofen toxicity (but this is a bit of a stretch).
Progression of Alzheimer's disease.
Worsening depression.
Digitalis intoxication.
Dementia due to Lewy bodies.
Ibuprofen toxicity.
The most likely cause is a digitalis intoxication, which would produce this slowing of conduction, which is seen in the heart rate.