Abstract
In 18 patients with gastrointestinal manifestations of digoxin toxicity the mean serum digoxin concentration (+/- SEM) was 3.16 micrograms/l (+/- 0.25), the calcium to potassium ratio 0.31 (+/- 0.01), and the mean arterial pH 7.406 (+/- 0.017). In contrast 19 patients with digoxin induced automaticity had a mean serum digoxin concentration of 1.24 micrograms/l (+/- 0.15; p less than 0.001), a calcium to potassium ratio of 0.38 (+/- 0.01; p less than 0.01), and an arterial pH of 7.498 (+/- 0.008; p less than 0.001). Eight out of 13 patients with digoxin induced cardiotoxicity had serum concentrations of the drug within the therapeutic range (0.8-2.0 micrograms/l). The calcium to potassium ratio, however, was lower than in the patients with automaticity (0.31 +/- 0.02; p less than 0.01) and the arterial pH was 7.370 (+/- 0.033; p less than 0.05). Serum magnesium concentrations were similar in all groups. In this study patients with digoxin induced gastrointestinal symptoms had high serum concentrations of the drug, whereas those with drug induced automaticity had therapeutic concentrations. This second group, however, was identified by their higher calcium to potassium ratios and higher pH values.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aronson J. K., Grahame-Smith D. G., Wigley F. M. Monitoring digoxin therapy. The use of plasma digoxin concentration measurements in the diagnosis of digoxin toxicity. Q J Med. 1978 Apr;47(186):111–122. [PubMed] [Google Scholar]
- BORISON H. L., WANG S. C. Physiology and pharmacology of vomiting. Pharmacol Rev. 1953 Jun;5(2):193–230. [PubMed] [Google Scholar]
- Beeler G. W., Jr, Reuter H. Membrane calcium current in ventricular myocardial fibres. J Physiol. 1970 Mar;207(1):191–209. doi: 10.1113/jphysiol.1970.sp009056. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Davidson S., Surawicz B. Ectopic beats and atrioventricular conduction disturbances. In patients with hypopotassemia. Arch Intern Med. 1967 Sep;120(3):280–285. [PubMed] [Google Scholar]
- Evered D. C., Chapman C. Plasma digoxin concentrations and digoxin toxicity in hospital patients. Br Heart J. 1971 Jul;33(4):540–545. doi: 10.1136/hrt.33.4.540. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fogelman A. M., La Mont J. T., Finkelstein S., Rado E., Pearce M. L. Fallibility of plasma-digoxin in differentiating toxic from non-toxic patients. Lancet. 1971 Oct 2;2(7727):727–729. doi: 10.1016/s0140-6736(71)92100-3. [DOI] [PubMed] [Google Scholar]
- Howard D., Smith C. I., Stewart G., Vadas M., Tiller D. J., Hensley W. J., Richards J. G. A prospective survey of the incidence of cardiac intoxication with digitalis in patients being admitted to hospital and correlation with serum digoxin levels. Aust N Z J Med. 1973 Jun;3(3):279–284. doi: 10.1111/j.1445-5994.1973.tb03096.x. [DOI] [PubMed] [Google Scholar]
- Ingelfinger J. A., Goldman P. The serum digitalis concentration--does it diagnose digitalis toxicity? N Engl J Med. 1976 Apr 15;294(16):867–870. doi: 10.1056/NEJM197604152941603. [DOI] [PubMed] [Google Scholar]
- Nola G. T., Pope S., Harrison D. C. Assessment of the synergistic relationship between serum calcium and digitalis. Am Heart J. 1970 Apr;79(4):499–507. doi: 10.1016/0002-8703(70)90255-3. [DOI] [PubMed] [Google Scholar]
- Singh R. B., Dube K. P., Srivastav P. K. Hypomagnesemia in relation to digoxin intoxication in children. Am Heart J. 1976 Aug;92(2):144–147. doi: 10.1016/s0002-8703(76)80248-7. [DOI] [PubMed] [Google Scholar]
- Smith T. W., Butler V. P., Jr, Haber E. Determination of therapeutic and toxic serum digoxin concentrations by radioimmunoassay. N Engl J Med. 1969 Nov 27;281(22):1212–1216. doi: 10.1056/NEJM196911272812203. [DOI] [PubMed] [Google Scholar]
- Tsien R. W., Carpenter D. O. Ionic mechanisms of pacemaker activity in cardiac Purkinje fibers. Fed Proc. 1978 Jun;37(8):2127–2131. [PubMed] [Google Scholar]