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Increased Salivary Calcium Levels as an Indicator of Digoxin Intoxication

Increased Salivary Calcium Levels as an Indicator of Digoxin Intoxication Abstract One hundred ten individuals were divided into patients with digoxin intoxication; patients treated with digoxin; patients treated with digoxin and diuretics; patients treated with diuretics; and control subjects. Measurement of salivary potassium and calcium levels showed that 81% of the patients with digoxin intoxication had noticeable elevation of the salivary calcium level. In 22%, elevation of the salivary calcium level preceded clinical manifestations of intoxication. The high calcium level in the saliva was not accompanied by changes in serum or urinary calcium levels. The elevation of salivary calcium levels can be used not only as an additional indicator of digoxin intoxication but also for detecting impending intoxication in patients treated with this drug. References 1. Smith TW, Butler VP Jr, Haber E: Determination of therapeutic and toxic serum digoxin concentration by radioimmunoassay. N Engl J Med 281:1212-1216, 1969.Crossref 2. Oliver GC, Parker BM, Brasfield DL, et al: The measurement of digitoxin in human serum by radioimmunoassay. J Clin Invest 47:1035-1042, 1968.Crossref 3. Lowenstein JM, Corrill EM: An improved method for measuring plasma and tissue concentrations of digitalis glycosides. J Lab Clin Med 67:1048-1052, 1966. 4. Beller GA, Smith TW, Abelmann WH, et al: Digitalis intoxication: A prospective clinical study with serum level correlations. N Engl J Med 284:989-997, 1971.Crossref 5. Fogelman AM, La Mont JT, Finkelstein S, et al: Fallibility of plasma-digoxin in differentiating toxic from non-toxic-patients. Lancet 2:727-729, 1971.Crossref 6. Jisalo E, Sundqvist H: The clinical usefulness of serum digoxin assay. Duodecim 88:630-638, 1972. 7. Wotman S, Bigger JT, Mandel ID, et al: Salivary electrolytes in the detection of digitalis toxicity. N Engl J Med 285:871-876, 1971.Crossref 8. Roos JC: Speekselelektrolyten en digitalisintoxicatie. Ned Tijdschr Geneeskd 116:1022, 1972. 9. Lankisch PG, Buckesfeld HP, Bolte HD, et al: Salivary electrolytes and digitalis intoxication. N Engl J Med 288:326, 1973. 10. Gould L, Reddy RCV, Gomprecht RF: Evaluation of digitalis toxicity by salivary electrolytes. N Engl J Med 286:47, 1972. 11. Kølendorf K, Christiansen NJB, Nielsen KS, et al: Serum-digoxin after dosage regimen based on body weight and renal function. Lancet 2:326, 1972.Crossref 12. Rauen HM: Biochemisches Taschenbuch. Berlin, Springer-Verlag, 1956, p 356. 13. O'Brien D, Jbrof F, Prodgersen D: Laboratory Manual of Pediatric Microbiochemical Methods. New York, Harper & Row, 1968, pp 50 and 304. 14. Lely AH, Van Enter CHJ: Non-cardiac symptoms of digitalis intoxication. Am Heart J 83:149-152, 1972.Crossref 15. Vom Capeller D, Copeland GD, Stern TN: Digitalis intoxication: A clinical report of 148 cases. Ann Intern Med 50:869-878, 1959.Crossref 16. Kuno-Sakai H, Sakai H, Ritzmann SE: Interference of digitoxin with the radioimmunoassay of digoxin. Lancet 2:326-327, 1972.Crossref 17. Solomon HN, Reich SD: A source of error in digoxin radioimmunoassay. Lancet 2:1038, 1970.Crossref 18. Amggard EE, Chew LF, Kalman SM: A source of error in digoxin radioimmunoassay. N Engl J Med 287:935,1972. 19. Swanson M, Cacace L, Chun G, et al: Salivary calcium and potassium concentration in the detection of digitalis toxicity. Circulation 47:736-743, 1973.Crossref 20. Schneyer LH, Young JA, Schneyer CA: Salivary secretion of electrolytes. Physiol Rev 52:720-777, 1972. 21. Lee KS, Klaus W: The subcellular basis for the mechanism of ionotropic action of cardiac glycosides. Pharmacol Rev 23:193-261, 1971. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Increased Salivary Calcium Levels as an Indicator of Digoxin Intoxication

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Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1975.00330080031005
Publisher site
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Abstract

Abstract One hundred ten individuals were divided into patients with digoxin intoxication; patients treated with digoxin; patients treated with digoxin and diuretics; patients treated with diuretics; and control subjects. Measurement of salivary potassium and calcium levels showed that 81% of the patients with digoxin intoxication had noticeable elevation of the salivary calcium level. In 22%, elevation of the salivary calcium level preceded clinical manifestations of intoxication. The high calcium level in the saliva was not accompanied by changes in serum or urinary calcium levels. The elevation of salivary calcium levels can be used not only as an additional indicator of digoxin intoxication but also for detecting impending intoxication in patients treated with this drug. References 1. Smith TW, Butler VP Jr, Haber E: Determination of therapeutic and toxic serum digoxin concentration by radioimmunoassay. N Engl J Med 281:1212-1216, 1969.Crossref 2. Oliver GC, Parker BM, Brasfield DL, et al: The measurement of digitoxin in human serum by radioimmunoassay. J Clin Invest 47:1035-1042, 1968.Crossref 3. Lowenstein JM, Corrill EM: An improved method for measuring plasma and tissue concentrations of digitalis glycosides. J Lab Clin Med 67:1048-1052, 1966. 4. Beller GA, Smith TW, Abelmann WH, et al: Digitalis intoxication: A prospective clinical study with serum level correlations. N Engl J Med 284:989-997, 1971.Crossref 5. Fogelman AM, La Mont JT, Finkelstein S, et al: Fallibility of plasma-digoxin in differentiating toxic from non-toxic-patients. Lancet 2:727-729, 1971.Crossref 6. Jisalo E, Sundqvist H: The clinical usefulness of serum digoxin assay. Duodecim 88:630-638, 1972. 7. Wotman S, Bigger JT, Mandel ID, et al: Salivary electrolytes in the detection of digitalis toxicity. N Engl J Med 285:871-876, 1971.Crossref 8. Roos JC: Speekselelektrolyten en digitalisintoxicatie. Ned Tijdschr Geneeskd 116:1022, 1972. 9. Lankisch PG, Buckesfeld HP, Bolte HD, et al: Salivary electrolytes and digitalis intoxication. N Engl J Med 288:326, 1973. 10. Gould L, Reddy RCV, Gomprecht RF: Evaluation of digitalis toxicity by salivary electrolytes. N Engl J Med 286:47, 1972. 11. Kølendorf K, Christiansen NJB, Nielsen KS, et al: Serum-digoxin after dosage regimen based on body weight and renal function. Lancet 2:326, 1972.Crossref 12. Rauen HM: Biochemisches Taschenbuch. Berlin, Springer-Verlag, 1956, p 356. 13. O'Brien D, Jbrof F, Prodgersen D: Laboratory Manual of Pediatric Microbiochemical Methods. New York, Harper & Row, 1968, pp 50 and 304. 14. Lely AH, Van Enter CHJ: Non-cardiac symptoms of digitalis intoxication. Am Heart J 83:149-152, 1972.Crossref 15. Vom Capeller D, Copeland GD, Stern TN: Digitalis intoxication: A clinical report of 148 cases. Ann Intern Med 50:869-878, 1959.Crossref 16. Kuno-Sakai H, Sakai H, Ritzmann SE: Interference of digitoxin with the radioimmunoassay of digoxin. Lancet 2:326-327, 1972.Crossref 17. Solomon HN, Reich SD: A source of error in digoxin radioimmunoassay. Lancet 2:1038, 1970.Crossref 18. Amggard EE, Chew LF, Kalman SM: A source of error in digoxin radioimmunoassay. N Engl J Med 287:935,1972. 19. Swanson M, Cacace L, Chun G, et al: Salivary calcium and potassium concentration in the detection of digitalis toxicity. Circulation 47:736-743, 1973.Crossref 20. Schneyer LH, Young JA, Schneyer CA: Salivary secretion of electrolytes. Physiol Rev 52:720-777, 1972. 21. Lee KS, Klaus W: The subcellular basis for the mechanism of ionotropic action of cardiac glycosides. Pharmacol Rev 23:193-261, 1971.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 1, 1975

References