If you halved your renal function, your serum creatinine level will double.
When I was a lad, in pre-SI Units days, the mean serum creatinine was 1. So physicians would divide the standard dose for digoxin by the serum creatinine Takes a bit more mental arithmetic to do the same exercise these days.
Regards,
Elliott (come out of retirement to help Lanarkshire Biochemistry 2 days a week)
________________________________________
From: Clinical biochemistry discussion list [[log in to unmask]] On Behalf Of Graham Mould [[log in to unmask]]
Sent: 22 June 2011 13:35
To: [log in to unmask]
Subject: Re: Digoxin
Digoxin is virtually almost renally excreted, hence is very dependent on
renal function. Therefore any increase in creatinine concentration over
normality should alert you to the possibility of increased digoxin
concentrations for 'normal' therapeutic doses. There is no one
concentration which will determine its toxicity.
I always advised our clinicians that a potassium of less than 3 mmol/L would
always potentially increase the myocardial sensitivity to digoxin.
Although the digoxin target ranges that have been quoted by members are good
for adults, do remember that neonates tend to tolerate higher
concentrations.
(And to take a leaf out of Mike Hallworth's previous comment 'at the risk
of being thought a pedant, it is a drug concentration not a level).
Graham Mould
Graham Mould, PhD
Direct Tel: +44 (0) 1483 685785
Fax: +44 (0) 1483 573704
Email: [log in to unmask]
Web: www.xpertwitness.co.uk
XPC Services
Surrey Technology Centre
Surrey Research Park, Occam Road
Guildford
Surrey
GU2 7YG
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Ginny Lee
Sent: 22 June 2011 12:51
To: [log in to unmask]
Subject: Re: Digoxin
We have decided to ammend our digoxin comment to:
"The target range for digoxin is 0.5-1.0 ug/L for patients being treated for
heart failure. However, a range of 0.5-2.0 ug/L may be appropriate for some
patients. There is an increased risk of digoxin toxicity, even if the level
is within the therapeutic range, if there is hypokalaemia or renal
impairment"
At what potassium and creatinine levels should we start to think about
toxicity occuring within the therapetic range?
Thanks
Ginny
Dr Virginia Lee, PhD, FRCPath
Senior Clinical Scientist
Department of Chemical Pathology
Level 4 Sandringham Building
Leicester Royal Infirmary
Leicester
LE1 5WW
Tel: 0116 2586560
Fax: 0116 2586550
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