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Digoxin toxicity in patients with high serum digoxin concentrations
G D Park1, R Spector, M J Goldberg
1Department of Internal Medicine, College of Medicine, University of Iowa, Iowa City 52242.
The American Journal of the Medical Sciences
|December 1, 1987
Summary
Patients with elevated serum digoxin concentrations (SDCs) but no toxicity symptoms have a low risk of developing serious issues. Discontinuation of digoxin therapy is often sufficient treatment for these individuals.
Area of Science:
- Pharmacology
- Clinical Toxicology
- Cardiology
Background:
- Digoxin is a cardiac glycoside used to treat heart failure and arrhythmias.
- Elevated serum digoxin concentrations (SDCs) can indicate a risk of toxicity.
- Assessing the risk of toxicity in asymptomatic patients with high SDCs is crucial for clinical management.
Purpose of the Study:
- To determine the probability of developing digoxin toxicity in patients with SDCs > 3 ng/mL who initially show no signs or symptoms.
- To evaluate the clinical course and outcomes of such patients.
Main Methods:
- Retrospective study of 123 patients with SDCs > 3 ng/mL.
- Comparison of patients with (group 2) and without (group 1) initial signs/symptoms of digoxin toxicity.
- Analysis of SDCs, serum creatinine, and incidence of atrial fibrillation and coronary artery disease.
Main Results:
- Two of 54 asymptomatic patients (group 1) developed digoxin toxicity, with no significant morbidity.
- No significant differences were observed in SDCs, serum creatinine, or comorbidities between groups.
- Digoxin was reduced or discontinued in all but one patient in group 1.
Conclusions:
- Clinically stable patients with elevated SDCs but no toxicity symptoms are at low risk of serious toxicity.
- Discontinuation of digoxin therapy is generally adequate management for these patients.
- Further treatment beyond digoxin discontinuation is often unnecessary for asymptomatic patients with high SDCs.