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Unexplained increase in serum digoxin: a case report

M H Doolittle1, K Lincoln, S W Graves

  • 1Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115.

Clinical Chemistry
|March 1, 1994
PubMed
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A patient experienced extremely high serum digoxin levels post-cardiac surgery, leading to cardiac arrest. Investigations revealed potential interference with digoxin measurement, not just toxicity.

Area of Science:

  • Clinical Biochemistry
  • Cardiology
  • Pharmacology

Background:

  • Cardiac surgery patients may require management of arrhythmias like atrial fibrillation.
  • Digoxin is a medication used to control heart rate and rhythm.
  • Accurate serum digoxin monitoring is crucial for patient safety.

Observation:

  • A patient received a brief course of digoxin post-cardiac surgery.
  • Unexpectedly high serum digoxin levels were recorded, peaking at 9.3 micrograms/L after cardiac arrest.
  • Digoxin levels decreased significantly over time without further administration.

Findings:

  • The extremely elevated digoxin levels were verified but raised questions about assay accuracy.
  • Potential interference from digoxin-like immunoreactive factors was suspected.

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  • Analytical methods were employed to differentiate true digoxin from interfering substances.

    • Implications:

    • This case highlights the importance of considering assay interference in digoxin level interpretation.
    • Clinical decisions based solely on high digoxin levels may require further investigation.
    • Further research into analytical interferences in digoxin immunoassays is warranted.