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You are visiting an 80-year- old patient in her home. She is receiving 0.125 mg of oral digoxin (Lanoxin) daily. She also takes hydrochlorothiazide (HydroDIURIL) 50 mg bid. She complains of blurred vision and nausea. You observe that she is confused and disoriented at times. Which of the following might be the problem?

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