Insensitivity to Digoxin Associated with Hypocalcemia

Chopra, Deepak; Janson, Paul; Sawin, Clark T.

doi:10.1056/nejm197704212961607

Cited by 42 publications

(9 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hypocalcemia is also known to cause resistance to the inotropic action of digitalis that usually resolves with calcium supplementation (60). However, nowadays digoxin is not used in the acute management of CHF; thus this effect did not play a role in the clinical improvement of our patient.…”

Section: Discussionmentioning

confidence: 83%

Use of recombinant human parathyroid hormone in hypocalcemic cardiomyopathy

Ballane

Sfeir

Dakik³

et al. 2012

European Journal of Endocrinology

View full text Add to dashboard Cite

Hypocalcemia secondary to hypoparathyroidism is a rare cause of congestive heart failure. However, its early recognition and treatment lead to significant improvement in cardiac function. We report a middle-aged woman presenting with symptoms of heart failure with a serum calcium level of 3.7 mg/dl and a serum inorganic phosphate level of 17.6 mg/dl 22 years after subtotal thyroidectomy. Besides calcium and calcitriol supplementation, she was the first patient with severe hypocalcemic cardiomyopathy to be given off-label recombinant human parathyroid hormone (PTH) because of an elevated serum calcium–phosphate product. We discuss the management and outcome of the patient and then present a brief review of similar previously reported cases. We also describe the pivotal role of calcium ion and the potential role of PTH in maintaining myocardial contractility, effective natriuresis, and possible pathogenic mechanisms contributing to heart failure secondary to hypocalcemia and hypoparathyroidism.

show abstract

Section: Discussionmentioning

confidence: 83%

Use of recombinant human parathyroid hormone in hypocalcemic cardiomyopathy

Ballane

Sfeir

Dakik³

et al. 2012

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…Calcium is necessary for heart muscle cell contractility. CCF with the coexistence of low serum calcium levels is extremely resistant to conventional treatment (65). Serum calcium level should be corrected by intravenous calcium administration accompanied by oral vitamin D.…”

Section: Summary Of the Mechanisms Of Heart Injurymentioning

confidence: 99%

The heart in transfusion dependent homozygous thalassaemia today – prediction, prevention and management

Aessopos

Berdoukas

Tsironi

2007

European J of Haematology

View full text Add to dashboard Cite

Cardiac disease remains the major cause of death in thalassaemia major. This review deals with the mechanisms involved in heart failure development, the peculiar clinical presentation of congestive heart failure and provides guidelines for diagnosis and management of the acute phase of cardiac failure. It emphasizes the need for intensive medical – cardiac care and aggressive iron chelating management as, with such approaches, today, the patients outcomes can be favourable in the long term. It covers advances in the assessment of cardiac iron overload with the use of magnetic resonance imaging and makes recommendations for preventing the onset of cardiac problems by tailoring iron chelation therapy appropriate to the degree of cardiac iron loading found.

show abstract

“…Nifedipine [38] Prazosin [39] Propantheline [36] Quinidine [40,41] Spironolactone [42] Verapamil [43,44] [50] Increases risk of toxicity [51] Increases risk of toxicity [46] Increases risk of toxicity [48] Slightly increases risk of toxicity [49] Slightly increases risk of toxicity [61] Increases risk of toxicity [62] ably the most frequent factor contributing to digitalis toxicity• Although potassium infusions have not been shown to increase the maximum lethal dose of digoxin in experimental studies [45], and despite the fact that hypokalemia was not frequently found to be an independent risk factor for digoxin toxicity in large-scale clinical trials [5,6], there is some evidence to suggest that, in addition to having direct arrhythmogenic effects, hypokalemia decreases the threshold for digoxin toxicity [46,47]. Maintaining a serum potassium level > 4.0 mEq/L is particularly important in situations such as electrical cardioversion, where the sarcolemma is momentarily paralyzed and a loss of intracellular potassium down the chemical gradient occurs.…”

Section: -35% Decrease In Digoxin Absorptionmentioning

confidence: 99%

“…The effects of metabolic alkalosis on digoxin toxicity may be important when excessive doses of bicarbonate are given during cardiopulmonary resuscitation or when patients are hyperventilated by respirators. Finally, hypocalcemia [50] causes resistance to the effects of digoxin and marked hypercalcemia increases, or at least facilitates, digoxin toxicity, thereby altering the optimal digoxin level [51].…”

Section: -35% Decrease In Digoxin Absorptionmentioning

confidence: 99%

“…Also, because quinidine alters the volume of distribution of digoxin, starting this drug just prior to cardioversion can increase the risk of cardioversion-related digoxin toxicity. In order to minimize the risk of cardiotoxicity with cardioversion, progressively increasing energy levels (10,25,50,100,200, and 400 watt seconds}, maintaining potassium levels>4.0 mEq/L, witholding digoxin for 24 hours, and, in some cases, starting prophylactic lidocaine therapy or proceeding to the installation of temporary endocardial pacemakers have been advocated [66,67]. Clearly, when adequate precautions are taken, the risk of cardioversion-induced digoxin toxicity in patients with optimal digoxin levels is minimal [68].…”

Section: -35% Decrease In Digoxin Absorptionmentioning

confidence: 99%

See 1 more Smart Citation

How to digitalize and to maintain optimal digoxin levels in cogestive heart failure

Lambert

Rouleau

1989

Cardiovasc Drug Ther

View full text Add to dashboard Cite

Due to the narrow therapeutic-to-toxic ratio of digoxin, numerous studies have been done to assess the optimal digoxin level in patients with congestive heart failure. A digoxin level of 0.7-1.5 ng/mL (or 0.9-2.0 nMol/L) is generally considered optimal, but even at these levels toxicity may occur in certain clinical situations such as severe pulmonary disease or when electrolyte or metabolic disturbances are present. The optimal daily maintenance dose of digoxin depends on the preparation given and can be calculated by the equation of Jelliffe, which is largely based on the creatinine clearance of the patient. The daily digoxin dose must also be adjusted to take into consideration disease processes or concomitant drug therapy that can alter the volume of distribution, the biotransformation, or the excretion of the drug.

show abstract

Insensitivity to Digoxin Associated with Hypocalcemia

Cited by 42 publications

References 4 publications

Use of recombinant human parathyroid hormone in hypocalcemic cardiomyopathy

Use of recombinant human parathyroid hormone in hypocalcemic cardiomyopathy

The heart in transfusion dependent homozygous thalassaemia today – prediction, prevention and management

How to digitalize and to maintain optimal digoxin levels in cogestive heart failure

Contact Info

Product

Resources

About