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November 9, 1979

Digoxin Ups and Downs

Author Affiliations

Cook County Hospital Chicago

JAMA. 1979;242(19):2106. doi:10.1001/jama.1979.03300190046027

To be cast like Daniel into a den full of leonine toxicologists conjures up visions of fierce arguments about volumes of distribution and semilogarithmic graphs showing the slope of the decline of the offending poison and its predicted half-life. But before rushing to enroll in a summer makeup course in pharmacokinetics and trying to understand how a 70-kg, nongargantuan man can have a volume of distribution of 700 L, the potential victim might pause to remember that correlations between blood levels and clinical symptoms are at best imprecise, that what is being measured is not necessarily what is causing the symptoms, and that in no field of medicine have the tempestuous winds of therapeutic fashion been more violent than in the realm of toxicology.

For digoxin, everybody agrees that some of the drug can be removed by charcoal or resin hemoperfusion and that one may expect a clearance of some