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Digoxin Overdose and Hemoperfusion

Henry R. Wagner, MD
JAMA. 1980;244(1):29. doi:10.1001/jama.1980.03310010019013.
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To the Editor.—  The recent article entitled "Digoxin Overdose" by Warren and Fanestil (242:2100, 1979) reported on a 41-year-old woman who ingested "the entire contents of her recently deceased child's digoxin elixir bottle, a dose calculated to be 18 mg." Based on calculated digoxin clearance by hemoperfusion-hemodialysis, they concluded that less than 1% of the ingested dose could be removed by a five-hour hemodialysis; they proclaimed this method to be of unproved value. Dunea's editorial (242:2106, 1979) added some skeptical comments on this conclusion.Based on the wisdom that toddlers like to bottoms-up their digoxin bottle, the largest available bottles contain 60 mL of elixir, or 60 times 50 μg equal to 3 mg per bottle. Did the described patient drink a whole six-pack? Was the ingested dose correctly calculated, or maybe hemoperfusion is not that bad at all?


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