Relationship of Serum and Myocardial Digoxin Concentration to Electrocardiographic Estimation of Digoxin Intoxication

1978 ◽  
Vol 18 (1) ◽  
pp. 10-15 ◽  
Author(s):  
THEODORE L. BIDDLE ◽  
MICHAEL WEINTRAUB ◽  
LOUIS LASAGNA
Keyword(s):  
Digoxin Concentration ◽  
Digoxin Intoxication ◽  
Relationship Of

Digoxin Poisoning and Anuric Acute Renal Failure: Efficiency of the Treatment Associating Digoxin-Specific Antibodies (Fab) and Plasma Exchanges

2002 ◽  
Vol 25 (6) ◽  
pp. 538-541 ◽  
Author(s):  
P. Chillet ◽  
J.M. Korach ◽  
D. Petitpas ◽  
N. Vincent ◽  
L. Poiron ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Plasma Exchange ◽  
Digoxin Concentration ◽  
Serum Digoxin Concentration ◽  
Specific Antibodies ◽  
Cardiac Abnormalities ◽  
Serum Digoxin ◽  
Digoxin Intoxication ◽  
Digoxin Poisoning

Digoxin-specific antibodies (Fab) are currently the treatment of choice for digoxin intoxication. These fragments bind to digoxin, leading to Fab-digoxin complexes, and promote the release of receptor-bound digoxin. These complexes are renally excreted. In the case of anuria, they could be dissociated and lead to renewed intoxication. In this case plasma exchanges are proposed. We report the case of an anuric patient with digoxin intoxication, treated with a Fab injection, followed by a plasma exchange 16 hours later, a second Fab injection was given followed by two plasma exchanges, 38 and 86 hours later. The disappearance of cardiac abnormalities showed the efficiency of the Fab, the drop in serum digoxin concentration and the high digoxin concentration in the exchanged plasma indicate effective elimination. The association of Fab and plasma exchanges could be proposed in the case of digoxin intoxication in the anuric patient.

2. Report of a Suicidal Digoxin Intoxication: A Case Report

2002 ◽  
Vol 42 (3) ◽  
pp. 265-268 ◽  
Author(s):  
María S Rodríguez-Calvo ◽  
Rosa Rico ◽  
Manuel López-Rivadulla ◽  
José M Suárez-Peñaranda ◽  
José I Muñoz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Tachycardia ◽  
Dose Range ◽  
Rare Event ◽  
Digoxin Concentration ◽  
Serum Digoxin Concentration ◽  
Toxicological Study ◽  
Digitalis Glycosides ◽  
Digoxin Intoxication ◽  
The Mean

Digoxin is a cardiotonic glycoside that is primarily used in the treatment of heart failure, atrial fibrillation or flutter, and paroxysmal atrial tachycardia. Intoxication due to digitalis excess is a common problem in clinical practice because it is therapeutically effective within a narrow dose range. However, massive intoxication with digitalis glycosides following a suicidal attempt is a rare event. In this report we describe an overdose fatality involving digoxin in a suicidal 82-year-old man, in whom measurement of serum digoxin concentration is available. A toxicological study of our patient, approximately two and a half hours after ingestion of the drug, revealed digoxin concentrations within 12.2–13.2 ng/ml in the blood, while the mean therapeutic serum concentration ranged from 0.5 to 2 ng/ml.

Effect of Aging on the Incidence of Digoxin Toxicity

2000 ◽  
Vol 34 (4) ◽  
pp. 427-432 ◽  
Author(s):  
Takanori Miura ◽  
Ryoji Kojima ◽  
Youji Sugiura ◽  
Masaru Mizutani ◽  
Fumimaro Takatsu ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Therapeutic Range ◽  
Clinical Evidence ◽  
Digoxin Concentration ◽  
Blood Chemistry ◽  
Serum Digoxin Concentration ◽  
Normal Serum ◽  
Digoxin Toxicity ◽  
Relationship Of ◽  
The Relationship

OBJECTIVE: To evaluate the relationship of the therapeutic serum digoxin concentration (SDC) range (0.5–2 ng/mL, as recommended in previous clinical studies) with the incidence of digoxin toxicity during digoxin maintenance therapy. METHODS: Subjects included all inpatients (n = 462) and outpatients (n = 437) receiving digoxin oral maintenance therapy for heart failure and/or atrial fibrillation with tachycardia at Kosei Hospital, Anjo, Japan. SDC and blood chemistry analysis were determined, and a 24-hour Holter electrocardiographic recording was performed when the SDC was at the presumed steady-state concentration. RESULTS: Analysis of clinical data showed that there was an overlapping (toxic and nontoxic) range of SDCs in which the incidence of digoxin toxicity was patient-dependent (1.4–2.9 ng/mL). No patient exhibited signs or symptoms of digoxin toxicity when the SDC was <1.4 ng/mL; all patients had evidence of toxicity when the SDC was >3 ng/mL. Additionally, it was shown that the concentration range of this overlapping range tended to broaden and shift to lower concentrations with increasing age. Patients with signs of toxicity when their SDCs were in the overlapping range had normal serum creatinine, blood urea nitrogen, digoxin clearance, creatinine clearance, and potassium concentrations, except for a significantly higher mean age than patients without toxicity. The incidence of digoxin toxicity was dependent on increasing age in patients whose SDCs were within the recommended therapeutic range. Moreover, clinical evidence of digoxin toxicity in patients >71 years old was 26.5%, despite their SDCs falling between 1.4 and 2 ng/mL. CONCLUSIONS: Increased age is most likely associated with enhanced susceptibility to digoxin toxicity, possibly due to unknown pharmacodynamic changes. This raises the possibility that patients >71 years show clinical evidence of digoxin toxicity despite having SDCs within the recommended therapeutic range.

scholarly journals Relationship of Serum Digoxin Concentration to Mortality and Morbidity in Women in the Digitalis Investigation Group Trial

2005 ◽  
Vol 46 (3) ◽  
pp. 497-504 ◽  
Author(s):  
Kirkwood F. Adams ◽  
J. Herbert Patterson ◽  
Wendy A. Gattis ◽  
Christopher M. O’Connor ◽  
Craig R. Lee ◽  
...  
Keyword(s):  
Digoxin Concentration ◽  
Serum Digoxin Concentration ◽  
Mortality And Morbidity ◽  
Serum Digoxin ◽  
Relationship Of ◽  
Group Trial

The relationship of the scleractinian corals to the rugose corals

Paleobiology ◽  
1980 ◽  
Vol 6 (02) ◽  
pp. 146-160 ◽  
Author(s):  
William A. Oliver
Keyword(s):  
Critical Points ◽  
Scleractinian Corals ◽  
Convincing Evidence ◽  
Early Triassic ◽  
Rugose Corals ◽  
History Of ◽  
The Subject ◽  
Relationship Of ◽  
The Relationship ◽  
Biologic Factors

The Mesozoic-Cenozoic coral Order Scleractinia has been suggested to have originated or evolved (1) by direct descent from the Paleozoic Order Rugosa or (2) by the development of a skeleton in members of one of the anemone groups that probably have existed throughout Phanerozoic time. In spite of much work on the subject, advocates of the direct descent hypothesis have failed to find convincing evidence of this relationship. Critical points are:(1) Rugosan septal insertion is serial; Scleractinian insertion is cyclic; no intermediate stages have been demonstrated. Apparent intermediates are Scleractinia having bilateral cyclic insertion or teratological Rugosa.(2) There is convincing evidence that the skeletons of many Rugosa were calcitic and none are known to be or to have been aragonitic. In contrast, the skeletons of all living Scleractinia are aragonitic and there is evidence that fossil Scleractinia were aragonitic also. The mineralogic difference is almost certainly due to intrinsic biologic factors.(3) No early Triassic corals of either group are known. This fact is not compelling (by itself) but is important in connection with points 1 and 2, because, given direct descent, both changes took place during this only stage in the history of the two groups in which there are no known corals.

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