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Hemofiltration for Digoxin Toxicity

Hemofiltration for Digoxin Toxicity Abstract To the Editor. —Regarding the article by Lai et al on "Hemofiltration in Digoxin Overdose" that appeared in the June issue of the Archives,1 I should like to point out that only about 15% to 20% (0.15 to 0.25) of digoxin is protein bound, contrary to the figure quoted by the authors.2 This should make possible the hemoperfusion of even more digoxin. I adopt the view that despite the modest fall in serum digoxin level, the amount of digoxin removed from the body was minute compared with total body stores of the drug. The major reservoir for the drug is skeletal muscle. Cardiac muscle contains about 30 times the amount present in serum.3,4 One hundred fifty billionths of a gram per minute removed for two days would result in a total removal of 720 000 ng of digoxin—a very small amount. Clinical improvement in this patient probably References 1. Lai KN, Swaminathan R, Pun CO, et al: Hemofiltration in digoxin overdose. Arch Intern Med 1986;146:1219-1220.Crossref 2. Storstein L: Studies on digitalis. The influence of renal function, hemodialysis and drug interaction on serum protein binding of digoxin and digitoxin. Clin Pharmacol Ther 1976;20:6-13. 3. Doherty JE, Hall WH: Tritiated digoxin XV serum protein binding in human subjects. Am J Cardiol 1971;28:326-330.Crossref 4. Doherty JE, Perkins WH: The tissue distribution of digoxin in human subjects. Ann Intern Med 1966;64:1158.Crossref 5. Ackerman GL, Doherty JE, Flanigan WJ: Peritoneal and hemodialysis of tritiated digoxin. Ann Intern Med 1967;67:718-723.Crossref 6. Smith TW, Butler VP Jr, Haber E, et al: Treatment of life-threatening digitalis intoxication with digoxin-specific Fab fragments: Experience in 26 cases. N Engl J Med 1982;307: 1357-1362.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Hemofiltration for Digoxin Toxicity

Archives of Internal Medicine , Volume 146 (11) – Nov 1, 1986

Hemofiltration for Digoxin Toxicity

Abstract

Abstract To the Editor. —Regarding the article by Lai et al on "Hemofiltration in Digoxin Overdose" that appeared in the June issue of the Archives,1 I should like to point out that only about 15% to 20% (0.15 to 0.25) of digoxin is protein bound, contrary to the figure quoted by the authors.2 This should make possible the hemoperfusion of even more digoxin. I adopt the view that despite the modest fall in serum digoxin level, the amount of digoxin removed from the body was...
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References (9)

Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1986.00360230233035
Publisher site
See Article on Publisher Site

Abstract

Abstract To the Editor. —Regarding the article by Lai et al on "Hemofiltration in Digoxin Overdose" that appeared in the June issue of the Archives,1 I should like to point out that only about 15% to 20% (0.15 to 0.25) of digoxin is protein bound, contrary to the figure quoted by the authors.2 This should make possible the hemoperfusion of even more digoxin. I adopt the view that despite the modest fall in serum digoxin level, the amount of digoxin removed from the body was minute compared with total body stores of the drug. The major reservoir for the drug is skeletal muscle. Cardiac muscle contains about 30 times the amount present in serum.3,4 One hundred fifty billionths of a gram per minute removed for two days would result in a total removal of 720 000 ng of digoxin—a very small amount. Clinical improvement in this patient probably References 1. Lai KN, Swaminathan R, Pun CO, et al: Hemofiltration in digoxin overdose. Arch Intern Med 1986;146:1219-1220.Crossref 2. Storstein L: Studies on digitalis. The influence of renal function, hemodialysis and drug interaction on serum protein binding of digoxin and digitoxin. Clin Pharmacol Ther 1976;20:6-13. 3. Doherty JE, Hall WH: Tritiated digoxin XV serum protein binding in human subjects. Am J Cardiol 1971;28:326-330.Crossref 4. Doherty JE, Perkins WH: The tissue distribution of digoxin in human subjects. Ann Intern Med 1966;64:1158.Crossref 5. Ackerman GL, Doherty JE, Flanigan WJ: Peritoneal and hemodialysis of tritiated digoxin. Ann Intern Med 1967;67:718-723.Crossref 6. Smith TW, Butler VP Jr, Haber E, et al: Treatment of life-threatening digitalis intoxication with digoxin-specific Fab fragments: Experience in 26 cases. N Engl J Med 1982;307: 1357-1362.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1986

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