Massive ingestion of cardiac drugs: toxicokinetic aspects of digoxin and sotalol during hemofiltration

Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
Verena C MulderEric J F Franssen

Abstract

We present the case of a 75-year-old patient admitted to the emergency department after ingesting a large amount of several cardiac drugs, among which were digoxin and sotalol. Because of renal insufficiency, cardiogenic shock, and high serum digoxin levels, the patient received continuous venovenous hemofiltration (CVVH) and digoxin-specific Fab fragments. Digoxin and the digoxin-specific Fab fragments are normally cleared by the kidneys. Serum-free and total digoxin and serum sotalol concentrations were monitored for several days. Less than 10% of the estimated ingested dose of digoxin was cleared by CVVH within 5 days. CVVH has little influence on the clearance of Fab-bound digoxin from the body. In contrast, sotalol is efficiently cleared by CVVH.

References

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Aug 24, 2007·Expert Opinion on Pharmacotherapy·Joachim Boldt, Stephan Suttner
Feb 20, 2009·Anesthesia and Analgesia·Tero VarpulaJouni Kurola

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Citations

Jan 23, 2016·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·James B MowryUNKNOWN EXTRIP Workgroup
Nov 20, 2013·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Scott T BenkenCybele Ghossein
Jun 12, 2021·Critical Care : the Official Journal of the Critical Care Forum·Josée BouchardUNKNOWN EXTRIP workgroup

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