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Reversal of digoxin-induced changes in erythrocyte electrolyte concentrations by penicillamine in children
Insights
Penicillamine effectively corrects digoxin intoxication by reducing serum digoxin levels. This study shows penicillamine also reverses digoxin-induced changes in red blood cell electrolytes, including calcium, potassium, and sodium.
Area of Science:
- Pharmacology
- Cardiology
- Clinical Medicine
Background:
- Penicillamine has previously demonstrated efficacy in reducing serum digoxin levels and treating digoxin intoxication.
- Understanding the precise mechanisms of penicillamine's antidigitalis effects is crucial for optimizing patient care.
Purpose of the Study:
- To investigate the effects of penicillamine on intracellular erythrocyte electrolyte concentrations in children with congestive heart failure undergoing digoxin therapy.
- To determine if penicillamine can reverse digoxin-induced alterations in red blood cell (RBC) electrolyte balance.
Main Methods:
- A prospective study involving 10 children (aged 4-14 years) with congestive heart failure receiving digoxin.
- Measurement of plasma and intracellular erythrocyte sodium (Na+), potassium (K+), and calcium (Ca++) levels, along with Na+/K+ and Na+/Ca++ ratios.
- Electrolyte levels were assessed before digitalization, after 6 days of digoxin maintenance, and 6 hours after oral penicillamine administration.
Main Results:
- Digoxin digitalization led to significant increases in RBC Na+, Ca++, Na+/K+, and Na+/Ca++ ratios, with a significant decrease in RBC K+.
- Penicillamine administration not only reduced serum digoxin levels but also significantly altered RBC electrolyte concentrations, shifting them back towards pre-digoxin values.
- Plasma and RBC magnesium levels remained unaffected by both digoxin and penicillamine.
Conclusions:
- Intra-erythrocyte calcium levels, in addition to RBC Na+ and K+ levels, serve as sensitive indicators of digoxin's effect.
- Penicillamine effectively reverses digoxin-induced electrolyte alterations within red blood cells, supporting its role in managing digoxin toxicity.
Abstract:
Previous reports from this laboratory have shown that penicillamine effectively reduces serum digoxin levels and is a clinically useful drug in correcting digoxin intoxication. To elucidate further the antidigitalis effects of penicillamine a prospective study was undertaken in 10 children aged 4--14 years with congestive heart failure. Plasma and intracellular erythrocyte concentrations of sodium, potassium, calcium as well as Na+/K+ and Na+/Ca++ ratios were measured before digitalization, 6 days after full digitalization while the patients were on maintenance doses of digoxin (0.02 mg/Kg/day, po, maximum 0.25 mg/day) and 6 hours after 1 Gm of oral penicillamine. After digitalization RBC Na+, Ca++, Na+/K+, and Na+/Ca++ increased, whereas RBC K+ levels decreased significantly. Administration of penicillamline not only reduced serum digoxin levels, but it also caused significant alterations in RBC electrolyte concentrations, toward pre-digoxin values. All values were significantly changed after penicillamine. Plasma and RBC magnesium levels were not altered significantly, neither after digitalization nor after penicillamine. It is concluded that in addition to RBC Na+ and K+ levels, intra-erythrocyte levels of calcium are sensitive indicators of digoxin effect; and that penicillamine reverses digoxin-induced RBC electrolyte alterations towards pre-digitalization values.