A recent digoxin on an elderly man was measured (on dilution) by the Beckman
Synchron CX5 as being 13.6 ug/L, this being (allegedly) some 24 hours after the
last dose. A call to the ward revealed the patient was not only alive and well
but actually walking around.
A repeat sample taken some 6 hours after the first one was 13.8 ug/L -so
interference seems a probability - no treatment with digibind was initiated.
The patients main complaint was COPD, having been admitted due to acute SOB.
(although this was later put down to heart failure rather than an acute
exacerbation of his COPD)
Renal function was impaired with a long standing diabetic nephropathy (urea 35
mmol/L, creatinine 180 to 210 umol/L).
Interestingly, the last measured digoxin (in the summer) was 1.0 ug/L, with the
renal function as impaired as above.
Medication at the moment is a mixtyure of antibiotics, nebulised salbutamol,
isosorbide mononitrate and spironolactone (and no steroids). This last one
might be a candidate for interference, but not according to the manufacturers
information. We are looking at his recent medication to see if he has been
started on anything new.
Does anybody have a non immunoassay method for digoxin?
Dr D G Williams FRCPath
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