Q: Why in lean people, Digoxin loading should be either avoided or given with less intensity.
Answer: The lean people with less skeletal mass have lower binding sites, and are prone to 'Dig. Toxicity at a lower level. It is distributed widely to skeletal muscle, cardiac tissue, and other lean tissues, with a large volume of distribution. For the same reason, it cannot be dialysed.
Digoxin has a very narrow therapeutic index and should be administered with extreme caution, taking into account other clinical factors. The following are important considerations while loading the digoxin.
- Hypokalemia
- Hypomagnesemia
- Hypercalcemia
- Hypoxemia
- Hypothyroidism
- Low muscle mass
- Renal insufficiency
#cardiology
#pharmacology
References:
1. Crane AD, Militello M, Faulx MD. Digoxin is still useful, but is still causing toxicity. Cleve Clin J Med. 2024 Aug 1;91(8):489-499. doi: 10.3949/ccjm.91a.23105. PMID: 39089856.
2. Peters AE, Chiswell K, Hofmann P, Ambrosy A, Fudim M. Characteristics and Outcomes of Suspected Digoxin Toxicity and Immune Fab Treatment Over the Past Two Decades-2000-2020. Am J Cardiol. 2022 Nov 15;183:129-136. doi: 10.1016/j.amjcard.2022.08.004. Epub 2022 Sep 9. PMID: 36089419; PMCID: PMC9588603.
No comments:
Post a Comment