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Falsely elevated serum digoxin levels secondary to endogenous digoxin-like immunoreactive substances
1Department of Emergency Medicine, The Medical College of Pennsylvania, Philadelphia, USA.
Summary
The human body produces digoxin-like immunoreactive substances (DLIS) that can interfere with drug tests. These substances cause falsely high digoxin levels, potentially leading to serious clinical misjudgments.
Area of Science:
- Clinical Chemistry
- Pharmacology
- Endocrinology
Background:
- Endogenous digoxin-like immunoreactive substances (DLIS) are naturally occurring compounds in the human body.
- Certain clinical conditions are associated with elevated levels of DLIS.
- Exogenous digoxin is a medication used for heart conditions.
Purpose of the Study:
- To highlight the diagnostic challenge posed by DLIS in digoxin testing.
- To explain the implications of DLIS interfering with digoxin assays.
- To underscore the importance of distinguishing DLIS from actual digoxin drug levels.
Main Methods:
- Review of existing literature on DLIS and digoxin assays.
- Analysis of clinical scenarios involving elevated DLIS.
- Discussion of immunoassay limitations in differentiating DLIS and digoxin.
Main Results:
- Commercially available digoxin assays often lack the specificity to differentiate DLIS from exogenous digoxin.
- DLIS do not share the therapeutic effects of exogenous digoxin.
- Elevated DLIS can lead to falsely reported or completely factitious digoxin levels.
Conclusions:
- The presence of DLIS can result in significant clinical consequences due to inaccurate digoxin measurements.
- Clinical interpretation of digoxin levels must consider the potential interference from endogenous substances.
- Further development of specific assays may be needed to accurately quantify digoxin in the presence of DLIS.