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Therapeutic digoxin level in chylous drainage with no detectable plasma digoxin level
M D Taylor1, S S Kim, L J Vaias
1Long Beach Veterans Administration Hospital, Department of Surgery, CA 90822, USA.
Chest
|November 21, 1998
Summary
Digoxin levels dropped significantly in a patient with congestive heart failure after chylothorax drainage. The drug was sequestered in chyle, leading to potentially subtherapeutic plasma concentrations.
Area of Science:
- Cardiology
- Pharmacology
- Thoracic Surgery
Background:
- A patient with a history of congestive heart failure was treated with digoxin.
- The patient underwent surgery for an infected aortic graft removal.
Observation:
- Following surgery, the patient developed a chylothorax.
- Drainage of the chylothorax led to a near-zero plasma concentration of digoxin.
- Therapeutic digoxin levels were detected in the chylous drainage fluid.
Findings:
- Lipid-soluble drugs, including digoxin, can be sequestered in chyle.
- Chylothorax drainage can result in significant drug loss from plasma.
Implications:
- Clinicians must recognize the potential for drug sequestration in chyle.
- Monitoring and dose adjustments may be necessary to prevent subtherapeutic drug levels in patients with chylothorax.
- This phenomenon is crucial for managing patients with congestive heart failure and chylothorax.