In a recent prospective study1 of 135 cardiac patients receiving digitalis before admission to hospital, a definite toxic reaction, as evidenced by symptoms, electrocardiograms, and digoxin blood levels, was demonstrated in 23% and its possible occurrence in 6%. Several studies2 have shown this complication to be responsible for nearly half of the drug-induced in-hospital patient deaths. With a frequency and a mortality that high, one cannot afford to ignore any means of simplifying, speeding, or confirming early diagnosis of a toxic reaction to digitalis.
The measurement of salivary potassium and calcium concentrations promises to be of help. In 18 patients with a toxic reaction to digitalis, Wotman and associates3 demonstrated higher values of these electrolytes than in 17 patients receiving the drug without a toxic reaction and in 16 normal subjects. Potassium concentration alone was sufficiently elevated to identify the majority of toxic reaction cases. When results
Salivary Electrolytes In Digitalis Toxicity. JAMA. 1973;225(5):519. doi:10.1001/jama.1973.03220320049017