What could be the cause of this decrease in digoxin level, Other Subject

What could be the cause of this decrease in digoxin level

Problem

A 59 year old woman with history of atrial fibrillation and diabetes has been stable with a normal digoxin level of 0.8-2 ng/dl for the past 9 months. Today, the result was 0.4 ng/dl. what could be the cause of this decrease in digoxin level?

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