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December 1, 1978

Detecting Digitalis Toxicity

JAMA. 1978;240(23):2542. doi:10.1001/jama.1978.03290230034016

To the Editor.—  In response to the article "How and When To Use the Digitalis Serum Levels" (239:2594, 1978), the author aptly discusses the current state of the digoxin serum level and its problems of interpretation. But he fails to stress that the clinician may be ordering digoxin levels for the wrong reason, thereby leading to possible inappropriate clinical decisions.With the wide use of digoxin levels, the clinician may use the serum digoxin level as a diagnostic guide to drug effect on the body (digoxin toxicity) instead of regarding the serum levels primarily as a guide to the effect of the body on the drug, in other words that the clinician is basing the diagnosis of toxicity on serum levels alone.If we bear in mind that digitalis toxicity is the result of the interaction of many factors, which have been mentioned elsewhere,1 it may be inaccurate to