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April 13, 1979, Vol 241, No. 15 >

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ARTICLE | April 13, 1979

Hemoperfusion in Drug Overdose

Curt R. Freed, MD; John G. Gerber, MD; Joseph Gal, PhD; Barry H. Rumack, MD; Alan S. Nies, MD
JAMA. 1979;241(15):1575. doi:10.1001/jama.1979.03290410015009.
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To the Editor.—  We were surprised to read the article by Smiley et al (240:2736, 1978) and the editorial and letter in the same issue that stated hemoperfusion was effective for digoxin poisoning. The data presented by Smiley et al in case 1 and by Gleeson et al (240:2731, 1978) in fact show no effect of hemoperfusion. The data of Smiley et al actually show an increase in plasma digoxin concentration during four hours of hemoperfusion (plasma clearance, 3.23 to 3.64 ng/mL). Gleeson et al show that the blood level fell from 9.9 to 5.0 ng/mL in 24 hours. This half-life is only slightly shorter than the usual half-life of 30 to 36 hours.1The reason for the failure of both hemodialysis and hemoperfusion is that while these methods can clear drugs from 100 to 200 mL of blood per minute, digoxin is distributed in an apparent volume of

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