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Relation between plasma and red-cell electrolyte concentrations and digoxin levels in children
Insights
Digoxin therapy alters red-cell electrolytes, increasing sodium and decreasing potassium. These electrolyte changes, particularly the sodium-to-potassium ratio, are sensitive indicators of digoxin toxicity in children.
Area of Science:
- Pediatric Cardiology
- Clinical Pharmacology
- Biochemistry
Background:
- Digoxin is a cardiac glycoside used to treat heart failure.
- Electrolyte balance is crucial for cardiac function.
- Digoxin toxicity can lead to serious adverse effects.
Purpose of the Study:
- To investigate the impact of digoxin on red-cell electrolyte concentrations in children.
- To identify electrolyte alterations associated with digoxin administration and toxicity.
Main Methods:
- Measured plasma and red-cell electrolyte concentrations (sodium and potassium) in children.
- Compared electrolyte levels in children with heart failure, those on maintenance digoxin, those with digoxin toxicity, and healthy controls.
Main Results:
- Digoxin therapy significantly increased red-cell sodium and decreased red-cell potassium.
- Children with digoxin toxicity exhibited higher red-cell sodium and lower red-cell potassium compared to nontoxic patients.
- The ratio of red-cell sodium to potassium was significantly higher in toxic patients.
Conclusions:
- Red-cell electrolyte alterations are sensitive indicators of digoxin's effects.
- Monitoring red-cell sodium and potassium levels may aid in detecting digoxin toxicity in pediatric patients.
Abstract:
We determined alterations in plasma and red-cell electrolyte concentrations associated with digoxin administration in 11 children in heart failure, 24 nontoxic patients receiving maintenance digoxin and 11 children in whom digoxin toxicity developed. Twenty normal children served as controls. Digoxin therapy was associated with a mean (+/- S.E.M.) increase in red-cell sodium from a pretreatment level of 6.2 +/- 0.7 meq per liter to 11.9 +/- 1.2 meq per liter and a decrease in red-cell potassium from 105.4 +/- 1.4 to 99.5 +/- 1.9 meq per liter (P less than 0.001). The red-cell sodium levels of toxic patients exceeded those of nontoxic patients whereas the potassium concentrations were lower (P less than 0.001). Toxic patients manifested significantly higher ratios of red-cell sodium to red-cell potassium (0.213 +/- 0.003) than nontoxic patients (0.085 +/- 0.008; P less than 0.001). Changes in red-cell electrolytes are sensitive indicators of digoxin affects.