Digoxin toxicit in chronic renal failure: treatment by multiple dose activated charcoal intestinal dialysis

1997 ◽  
Vol 16 (12) ◽  
pp. 733-735 ◽  
Author(s):  
Julian AJH Critchley ◽  
Lester AH Critchley
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Activated Charcoal ◽  
Multiple Dose ◽  
Digoxin Concentration ◽  
Digoxin Toxicity ◽  
Plasma Digoxin ◽  
Plasma Digoxin Concentration ◽  
Wide Range ◽  
Repeated Doses

1 Digoxin toxicity can result from overdose or iatrogenic causes, especially if renal function is impaired. 2 We present a case of digoxin toxicity presenting with severe bradycardia and hypotension in a 66 year old man with chronic renal failure. Regular haemodia lysis had, as predicted, failed to reduce his plasma digoxin concentration. Digoxin specific antibody fragments (Fab) were not readily available and their use was probably inappropriate as they are normally renally eliminated. 3 The patient was successfully treated by two prolonged courses of intestinal dialysis with repeated doses of activated charcoal over 48 and 72 h and totaling 400 g and 600 g, respectively. However, the patient found the activated charcoal extremely unpalatable. 4 Multiple dose activated charcoal intestinal dialysis (MDACID) has been recently advocated for use in a wide range of poisonings. The technique takes advantage of the large surface area of the small intestine to eliminate drugs and metabolites, over several days if necessary. The pharmacokinetics of digoxin toxicity in chronic renal failure make intest inal dialysis an appropriate method of treatment but the realisation of the true potential of this technique awaits a more palatable absorbent or formulation.

Lanoxitest - digoxin radio-immunoassay kit

1972 ◽  
Vol 10 (1) ◽  
pp. 1.2-3
Keyword(s):  
Renal Failure ◽  
Digoxin Concentration ◽  
The Elderly ◽  
Underlying Disease ◽  
Digoxin Toxicity ◽  
Toxic Effects ◽  
Plasma Digoxin ◽  
Plasma Digoxin Concentration ◽  
Radio Immunoassay

Digoxin toxicity is a relatively common problem.1 It occurs often in the elderly, in patients with renal failure and in those with hypokalaemia; in all these the diagnosis is particularly difficult as many of the indications of toxicity, such as anorexia, nausea, vomiting and most of the arrhythmias are apt to be caused by the underlying disease. The problem can be resolved in normokalaemic patients by knowing the plasma digoxin concentration, for in these patients there is a good correlation between the concentration of digoxin in the plasma and the development of therapeutic or toxic effects.

scholarly journals Evaluating plasma Digoxin concentration after an intravenous loading dose in patients with renal failure

2021 ◽  
pp. 033-037
Author(s):  
Eslami Vahid ◽  
Mortezapour Fatemeh ◽  
Samavat Shiva ◽  
Ziae Shadi ◽  
Gheymati Azin
Keyword(s):  
Renal Failure ◽  
Digoxin Concentration ◽  
Loading Dose ◽  
Plasma Digoxin ◽  
Plasma Digoxin Concentration

An Assessment of Digoxin Radio-Immunoassay

1973 ◽  
Vol 18 (3) ◽  
pp. 69-74 ◽  
Author(s):  
B. Whiting ◽  
D. J. Sumner ◽  
A. Goldberg
Keyword(s):  
Renal Failure ◽  
Plasma Volume ◽  
Attempted Suicide ◽  
Digoxin Concentration ◽  
Dosage Schedule ◽  
Plasma Digoxin ◽  
Plasma Digoxin Concentration ◽  
Radio Immunoassay ◽  
Digoxin Poisoning

Using a commercially available digoxin radio-immunoassay kit, an accuracy of the order of ±10 per cent has been achieved. Precision could be improved by increasing the ratio (volume of plasma/volume of radioactive digoxin). The assay permitted separation of clinically toxic and non-toxic patients with plasma digoxin values of 3.5±0.6 (S.D.) ng. per ml. and 1.4±0.6 ng. per ml. respectively (p <0.001). A correlation between blood urea and plasma digoxin concentration was demonstrated (r=0.57, p <0.001). The assay was particularly useful in the confirmation and follow-up of suspected digoxin poisoning in attempted suicide, and in renal failure to arrive at a modified digoxin dosage schedule.

Digoxin Immune Fab Administration following an Unexplained Increase in Serum Digoxin Concentration

1994 ◽  
Vol 10 (6) ◽  
pp. 246-249
Author(s):  
Augustine S. Aruna ◽  
Sandra G. Jue
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Elevated Serum ◽  
Clinical Signs ◽  
Digoxin Concentration ◽  
Serum Digoxin Concentration ◽  
Digoxin Toxicity ◽  
Personal Contact ◽  
Serum Digoxin ◽  
Digoxin Metabolites

Objective: To report a case of digoxin immune Fab (DIF) administration following an unexplained increase in serum digoxin concentration in an asymptomatic patient with chronic renal failure. Case Summary: A 70-year-old man presented to the hospital with congestive heart failure, atrial fibrillation, chronic renal failure, and suspected digoxin toxicity. By day 3, he developed a more stable cardiac rhythm with nodal beats. His last known digoxin dose was 12 hours prior to admission. No explanation for an elevated serum digoxin concentration 48 hours after admission could be found. Despite absence of other signs of digoxin toxicity, DIF 80 mg iv was administered, and was immediately followed by 40 mg. Discussion: This case illustrates that elevated digoxin concentrations may be observed in patients with renal failure. These may not be true high concentrations because of the following potential factors: (1) the presence of digoxin-like factors, (2) increased biotransformation of digoxin, and (3) accumulation of metabolites that interfere with the assay. Digoxin metabolites are known to cross-react with the antibodies in commonly used digoxin immunoassays, and may be inappropriately interpreted to signal digoxin toxicity. Both the accuracy and reliability of digoxin immunoassay techniques have been questioned or challenged over the years. It is difficult to determine whether a reported toxic serum digoxin concentration represents the true concentration or cross-reactivity between digoxin metabolites and antibodies used in most digoxin immunoassays. Data Sources: Data collection sources included retrospective review of patient medical records, personal contact with one of the physicians involved in rendering patient care for interpretation of the electrocardiogram changes, clinical symptoms and rationale for DIF administration, and contact with the immunoassay technologist, who indicated that the fluorescence polarization immunoassay technique was used for analysis of digoxin concentrations. The medical literature then was reviewed. Conclusions: DIF should be reserved for use in symptomatic patients. Elevated digoxin concentrations must be evaluated for various factors that can cause falsely elevated values. Clinical signs and symptoms are critical in making the decision to use Fab. Antidotal measures should be based on correlation of patient symptoms with serum digoxin concentrations.

Peak Plasma Digoxin Concentration and Cardiotoxicity

1978 ◽  
pp. 273-283 ◽  
Author(s):  
B. F. Johnson ◽  
D. J. Chapple ◽  
R. Hughes ◽  
J. LaBrooy ◽  
I. Smith
Keyword(s):  
Peak Plasma ◽  
Digoxin Concentration ◽  
Plasma Digoxin ◽  
Plasma Digoxin Concentration
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