Digoxin toxicity: an evaluation in current clinical practice.
Journal Article
Background
Serum digoxin concentrations (SDCs) are frequently sampled before completion of drug distribution. If elevated, these concentrations may be misinterpreted, potentially leading to a misdiagnosis of digoxin toxicity.Objectives
To determine the frequency of elevated SDCs (>2.6 nmol/L [>2.0 ng/mL]) obtained at appropriate postdosing intervals and to evaluate the frequency of clinically defined digoxin toxicity in patients with elevated SDCs.Methods
The medical records of adult patients with SDCs assayed at 5 general hospitals in North Carolina during a 3-month period (May 1 through July 31, 1996) were prospectively evaluated. Data on SDC, inpatient or outpatient status, and medical or surgical service were collected for all patients. Data on patient demographics, serum chemistry values, indication for digoxin treatment, clinical evidence of digoxin toxicity, and timing of the blood sample relative to administration of the last dose of digoxin were collected for patients with SDCs higher than 2.6 nmol/L (>2.0 ng/mL).Results
Of 3434 SDCs assayed in 2009 patients, 320 (9.3%) were higher than 2.6 nmol/L (>2.0 ng/mL). Fifty-one (15.9%) of the 320 SDCs were drawn at 6 hours or less following a digoxin dose. Sampling time relative to the digoxin dose could not be determined in 70 (21.9%) of the 320 elevated SDCs, leaving 199 (62.2%) of 320 SDCs in 138 patients evaluable for digoxin toxicity. Eighty-three of the 138 patients had clinical evidence of digoxin toxicity for an overall incidence of 4.1%.Conclusions
Digoxin toxicity occurs less frequently than historically reported. Continued emphasis needs to be placed on obtaining appropriately timed SDCs.Full Text
Duke Authors
Cited Authors
- Williamson, KM; Thrasher, KA; Fulton, KB; LaPointe, NM; Dunham, GD; Cooper, AA; Barrett, PS; Patterson, JH
Published Date
- December 1998
Published In
Volume / Issue
- 158 / 22
Start / End Page
- 2444 - 2449
PubMed ID
- 9855382
Pubmed Central ID
- 9855382
Electronic International Standard Serial Number (EISSN)
- 1538-3679
International Standard Serial Number (ISSN)
- 0003-9926
Digital Object Identifier (DOI)
- 10.1001/archinte.158.22.2444
Language
- eng