To the Editor.—
LCDR Sanford E. Warren, MC, USNR, and Darrell D. Fanestil, MD (242:2100, 1979), have questioned the value of hemoperfusion in digoxin overdoses, since serum levels but not tissue stores of digoxin are lowered.
Report of a Case.—
An 82-year-old woman spilled her tablets from a bottle of digoxin in her breakfast cereal. After removing six tablets, she then ate her cereal. Three hours later she had dizziness, vomiting, and atrial fibrillation with a ventricular response of 20 beats per minute. A temporary transvenous pacemaker was inserted. The digoxin level was 11.6 ng/mL, and hemoperfusion was carried out for six hours, using coated activated charcoal (Adsorba 300C). Blood flow rates of 300 mL/min were achieved. Digoxin clearances by hemoperfusion were calculated by the following equation: C=QB (Ci-Co)/Ci where Qb is the blood flow rate, Ci is the digoxin concentration in the arterial line, and Co is the digoxin
Rowett DA. Failure of Hemoperfusion in Digoxin Overdose. JAMA. 1980;244(14):1558. doi:10.1001/jama.1980.03310140018009