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Correlation of antemortem and postmortem digoxin levels
1Department of Anatomic and Clinical Pathology, St. Paul-Ramsey Hospital, Minn. 55101.
Insights
Postmortem serum digoxin levels are higher than antemortem values, varying by sampling site. Femoral venous serum combined with vitreous humor best indicates antemortem digoxin toxicity.
Area of Science:
- Forensic Toxicology
- Clinical Chemistry
- Pharmacokinetics
Background:
- Digoxin levels in postmortem serum often exceed antemortem measurements.
- Understanding serum digoxin distribution postmortem is crucial for toxicological analysis.
Purpose of the Study:
- To investigate the variation in serum digoxin levels between antemortem and postmortem samples.
- To determine the optimal sampling site and combination of samples for assessing antemortem digoxin toxicity.
Main Methods:
- Comparison of serum digoxin levels from heart, subclavian vein, and femoral vein samples.
- Analysis of postmortem interval's effect on digoxin level changes.
- Evaluation of combined femoral venous serum and vitreous humor for toxicity assessment.
Main Results:
- Postmortem serum digoxin levels consistently exceeded antemortem values across all sampling sites.
- Mean postmortem to antemortem ratios were 1.96 (heart), 1.63 (subclavian vein), and 1.42 (femoral vein).
- No correlation was found between postmortem interval and the increase in serum digoxin levels.
Conclusions:
- Serum digoxin levels increase significantly after death, with variations based on sampling location.
- Combining femoral venous serum and vitreous humor provides the most reliable data for evaluating potential antemortem digoxin toxicity.
Abstract:
Postmortem serum digoxin levels from any source routinely exceed antemortem values. Variation resulting from site of sampling gave a mean postmortem to antemortem ratio of 1.96 for heart, 1.63 for subclavian vein, and 1.42 for femoral vein samples. No correlation could be made between the postmortem interval and the increase in post-mortem serum values, irrespective of the site of sampling. A combination of femoral venous serum and vitreous humor values gave the best information for determining possible antemortem digoxin toxicity.