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Digoxin toxicity: an evaluation in current clinical practice
K M Williamson1, K A Thrasher, K B Fulton
1Quintiles Cardiovascular Therapeutics, Quintiles Inc, Research Triangle Park, NC, USA.
Archives of Internal Medicine
|December 17, 1998
Summary
Elevated serum digoxin concentrations (SDCs) are often due to improper timing, not toxicity. Ensuring correct blood draw timing is crucial for accurate digoxin toxicity assessment.
Area of Science:
- Pharmacology
- Clinical Chemistry
- Internal Medicine
Background:
- Serum digoxin concentrations (SDCs) are frequently measured prematurely, potentially leading to misinterpretation.
- Prematurely drawn SDCs may be falsely elevated, causing misdiagnosis of digoxin toxicity.
Purpose of the Study:
- To determine the frequency of elevated SDCs (>2.6 nmol/L) drawn at appropriate intervals.
- To evaluate the incidence of clinically defined digoxin toxicity in patients with elevated SDCs.
Main Methods:
- Prospective evaluation of medical records from 5 North Carolina hospitals over 3 months.
- Collected data included SDC, patient status, service, demographics, serum chemistry, digoxin indication, toxicity signs, and blood sample timing relative to the last digoxin dose.
- Focused analysis on patients with SDCs > 2.6 nmol/L.
Main Results:
- 9.3% of 3434 SDCs were elevated (>2.6 nmol/L).
- 15.9% of elevated SDCs were drawn ≤6 hours post-dose; timing was unknown for 21.9%.
- Of 138 evaluable patients with elevated SDCs, 4.1% exhibited clinical digoxin toxicity.
Conclusions:
- Clinical digoxin toxicity is less frequent than historical reports suggest.
- Emphasizing appropriately timed SDC sampling is essential for accurate diagnosis and patient management.