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To the Editor.—
In a recent issue of The Journal, a query by Adalberto Mendoza, MD (243:1275, 1980), regarding availability of blood digoxin levels is answered appropriately by Jay N. Cohn, MD.There is one point deserving emphasis that is at variance with the statement in reply that serious cases of arrhythmia would likely receive the same treatment regardless of whether digitalis is present. This point is that a major hazard for the patient is the likelihood of receiving digitalis for supraventricular arrhythmias when, in fact, the arrhythmia could be digitalis induced; if the clinician knows that the patient has received digitalis (ie, a detectable blood level is present), clinical judgment would dictate the use of alternative therapy. Knowing the exact level of digoxin in the blood is somewhat less helpful in making this distinction, although a general correlation with high levels and toxic effects is well established.A specific
Haywood LJ. Emergency Blood Digoxin Level Measurement. JAMA. 1980;244(12):1319. doi:10.1001/jama.1980.03310120013009
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