digoxin and Anuria

Topics: Administration, Oral; Anuria; Digitoxin; Digoxin; Glomerular Filtration Rate; Half-Life; Humans; Kidney; Kinetics; Mathematics; Time Factors

Topics: Antidotes; Anuria; Cardiovascular Diseases; Digoxin; Dose-Response Relationship, Drug; Drug Administration Schedule; Electrocardiography; Emergency Service, Hospital; Female; Humans; Male; Prognosis; Risk Assessment

Digoxin-specific antibodies (Fab) are currently the treatment of choice for digoxin intoxication. These fragments bind to digoxin, leading to Fab-digoxin complexes, and promote the release of receptor-bound digoxin. These complexes are renally excreted. In the case of anuria, they could be dissociated and lead to renewed intoxication. In this case plasma exchanges are proposed. We report the case of an anuric patient with digoxin intoxication, treated with a Fab injection, followed by a plasma exchange 16 hours later, a second Fab injection was given followed by two plasma exchanges, 38 and 86 hours later. The disappearance of cardiac abnormalities showed the efficiency of the Fab, the drop in serum digoxin concentration and the high digoxin concentration in the exchanged plasma indicate effective elimination. The association of Fab and plasma exchanges could be proposed in the case of digoxin intoxication in the anuric patient.

Topics: Acute Kidney Injury; Aged; Anti-Arrhythmia Agents; Anuria; Digoxin; Humans; Immunoglobulin Fab Fragments; Male; Plasma Exchange

Topics: Acute Kidney Injury; Aged; Anuria; Digoxin; Female; Humans; Immunoglobulin Fab Fragments

The influence of quinidine 750mg per day for one week on serum digoxin concentration (SDC) was evaluated in digitalized anuric patients on chronic haemodialysis. During quinidine administration the SDC increased markedly, from 0.84 +/- 0.37 to 1.58 +/- 0.72 ng/ml (p less than 0.01), a comparable effect ot that reported previously in patients with normal renal function. Neither in vitro nor in vivo did quinidine alter the serum protein binding of digoxin. The increase in SDC in anuric patients indicates a decrease in the extrarenal clearance of digoxin, which means that mechanisms other than of renal origin are also involved in the interaction of quinidine and digoxin. There was great interindividual variability in the extent of the quinidine-induced rise in SDC. Regardless of the state of renal function, careful monitoring of digitalized patients seems mandatory once quinidine treatment is initiated.

Topics: Anuria; Blood Proteins; Bundle-Branch Block; Digoxin; Drug Interactions; Female; Humans; Male; Middle Aged; Protein Binding; Quinidine; Renal Dialysis

The pharmacokinetics of 3H-labeled digoxin and metildigoxin were compared in six anuric patients. The following means +/- s.e.m. were obtained: extrarenal clearance of digoxin, 43.3 +/- 5.4 ml/min, of metildigoxin, 30.3 +/- 2.9 ml/min; distribution volume of digoxin, 315 +/- 29 1, of metildigoxin, 258 +/- 22 1; rate constant for elimination of digoxin, 0.0086 +/- 0.0013 h-1, of metildogixon, 0.0071 +/- 0.0007 h-1. The elimination rates correspond to half-lives of 80 h for digoxin and of 97 h for metildigoxin. From our investigations and published data a weighed mean of 47 ml/min was calculated for the extrarenal clearance of metildigoxin. This is not significantly different from the mean extrarenal clearance of 40 ml/min reported for digoxin. A total body clearance of 40 ml/min and a daily intravenous dose of 0.1 mg correspond to an average steady-state glycoside concentration of 1.74 ng/ml.

Topics: Anuria; Digoxin; Humans; Medigoxin; Metabolic Clearance Rate; Renal Dialysis

Plasma digoxin suspected to be elevated in anuric patients taking digitoxin was determined by radioimmunoassay in 15 anuric patients and 15 normal persons subjected to 0.1 mg digitoxin therapy per day. All plasma digoxin values from the anuric patients and the normal subjects were far below the lower limit of the therapeutic range of plasma digoxin. There existed no difference between the digoxin values determined in anuric patients and subjects with normal renal function; in both groups there was a scatter of digoxin values about the cross reaction line between digitoxin and digoxin antibody. It is concluded from the results that digoxin retention in anuric patients taking digitoxin plays an insignificant role; thus, the pharmacological effect is mediated by digitoxin itself.

Topics: Anuria; Digitoxin; Digoxin; Humans; Radioimmunoassay; Renal Dialysis

Serum digoxin values were determined in a newborn infant with severe heart failure and renal failure. The half-life of digoxin in the serum appeared to change, possibly the result of prolonged distribution and/or absorption owing to circulatory insufficiency, or to the accumulation of cross-reacting metabolites of digoxin in the serum. No clinical toxicity was apparent, and no cardiac arrhythmia was observed. The need for monitoring serum digoxin concentration and clinical effect in newborn infants is emphasized.

Topics: Anuria; Aortic Coarctation; Creatinine; Digoxin; Half-Life; Heart Failure; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male

The introduction of the Gamma Coat 125I-Digoxin Radioimmunoassay has simplified the digoxin determination to an extent that it may be used even in general hospitals with an intensive care unit. The total time for a stat determination has been reduced to 70 min. The coefficient of variation of the digoxin determination at low levels (less than 0.8 ng/ml) was less than 15% for simultaneous and repeated measurements even when using one of the inexpensive nuclear counting systems. At high levels (greater than 2.5 ng/ml) the coefficient of variation showed to be less than 6%. Hemolysis, low albumine concentration and other than digoxin-bound isotopes in the blood samples did not cause methologic problems. Provided that resorption and elimination kinetics of the different digoxin preparations were taken into account, digoxin levels of more than 2 ng/ml as measured by the Gamma Coat method in patients with normal renal function plasma were usually associated with clinical signs of overdosage; therapeutic concentrations were mostly higher than 1.2 ng/ml. The incidence of digitalis toxicity with high digoxin levels was lower in uremic than in normal patients. According to preliminary observations in dialysis patients this increase in tolerance to digitalis, may be a consequence of hyperkalemia and renal acidosis. Erroneously high digoxin concentrations were found in patients up to 2 hrs after injection of high doses of spironolactone (400-1000 mg) due to cross reaction. Therapeutic concentrations of digitoxin (10-25 ng/ml) caused only subtherapeutic digoxin concentrations of 0.4-0.9 ng/ml.

Topics: Anuria; Binding Sites, Antibody; Digoxin; Drug Tolerance; False Positive Reactions; Humans; Iodine Radioisotopes; Potassium; Radioimmunoassay; Renal Dialysis; Spironolactone; Tachycardia; Time Factors; Tritium

Topics: Aged; Anuria; Bacterial Infections; Bandages; Burns; Child; Debridement; Digoxin; Hospital Units; Humans; Infusions, Parenteral; Male; Mannitol; Penicillins; Plasma; Postoperative Care; Pseudomonas Infections; Skin Transplantation; Sulfanilamides; Transplantation, Autologous; Transplantation, Homologous; Wound Infection

Topics: Adolescent; Adult; Anuria; Cardiac Glycosides; Chromatography, Paper; Digitoxin; Digoxin; Female; Humans; Injections, Intravenous; Male; Middle Aged; Ouabain; Renal Dialysis; Tritium

Topics: Anuria; Atropine; Digoxin; Electrocardiography; Female; Humans; Injections, Intravenous; Liver Function Tests; Middle Aged

Topics: Animals; Anuria; Bile; Bile Ducts; Biliary Tract Diseases; Digitoxin; Digoxin; Drug Tolerance; Fluorescence; Lanatosides; Male; Mice; Ouabain

Topics: Acute Kidney Injury; Anuria; Chlorothiazide; Diabetes Mellitus; Digoxin; Geriatrics; Gout; Hydrochlorothiazide; Hypertension; Hypertension, Renal; Kidney; Renal Insufficiency; Toxicology