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Dr Wagner is on the mark when he notes that most digoxin elixir bottles contain at most 3 mg of the drug. We should have noted that the patient was in the habit of pooling medication, that she was, in fact, believed to have consumed the equivalent of several bottles of elixir. Nevertheless, even had the ingested dose been only 3 mg, we approximate a total drug removal of 0.04 mg with hemoperfusion-hemodialysis; this would still amount to only 1.3% of an ingested dose of 3 mg. Our conclusion that charcoal hemoperfusion is of unproved value in digoxin overdose stands.
Warren S. Digoxin Overdose and Hemoperfusion-Reply. JAMA. 1980;244(1):29. doi:10.1001/jama.1980.03310010019014