Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        Digoxin, serum
      

This is one of the heart (cardiac) medications in common use. The agent takes some hours to reach eqilibration and a steady level in the body. If measured in serial fashion, the serum level should be lowest (trough level) just prior to the next dose. And the peak level is at some point following the taking of a dose. Immunoassays are the methods used in labs for hospitals and rapid treatment decisions (and DLISs, see below, bedevil these assays...discovered in 1980).

Situations of decreased levels:

 

 

Factors and causes of elevated levels:

DLIS: watch out for "digoxin-like immuno-reacting substance" (both exogenous & endogenous substances)

  • uncommon in general population (identified 2-4 times per year in a 300 bed community hospital lab with 6000 ER (about year 2000) visits per month...Lex. Med. Center).
  • seen more commonly in young pediatric age group.
  • see endogenous more commonly in kidney disease (and other volume-expanded situations like liver disease & pregnancy) group.
  • exogenous agents are spironolactones, potassium canrenoate, and various Chinese medicines (such as Chan Su used in Liu-Shen-Wan and Kyushin; also danshen, Siberian & Asian & Indian ginseng; Uzara root; Oleander).
  • least likely to show up in a RIA test method (most such methods now in a relatively few reference labs...can't get rapid results).
  • if suspected, the quickest clue to DLIS might be significantly variable results on the same sample if tested in the local labs by more than one digoxin test method.

References:

  1. Dasgupta, Amitava, "Digoxin-like Substances Interfere with Immunoassays", June 2006 Clinical & Forensic Toxicology News.

(posted about 2000; most recent addition 19 June 2006)

 
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