Measurement of Digoxin in Plasma and its use in Diagnosis of Digoxin Intoxication

Grahame‐Smith, D. G.; Everest, M. S.

doi:10.1136/bmj.1.5639.286

Cited by 94 publications

(14 citation statements)

References 5 publications

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“…(2) There have been several recent reports of a significant incidence of toxicity in patients on this drug, particularly the elderly, but most published work is hospitaloriented and little is known of the problem in general practice. [5][6][7][8][9] (3) The study group was small and consequently caused little disturbance to normal practice routine. (4) I hoped that criteria for the adequate care of patients stabilised on digoxin could be established as a guideline, perhaps for trainees and as a basis for discussion among general practitioners.…”

Section: Objectivesmentioning

confidence: 99%

Long-term digoxin treatment in general practice.

Curtis¹

1975

BMJ

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SummaryA questionnaire was sent to several general practitioners and specialists in an attempt to obtain a consensus on standards of care for patients receiving long-term digoxin treatment. The consultants' suggested standards were slightly more stringent than those of the general practitioners. The records of 42 patients taking digoxin under the care of two general practitioners were studied to see how far their actual care matched up to the suggested standards. The models of management proposed by these patients' doctors were only slightly different from those suggested by other practitioners, but measured against these models the patients' care was in some cases inadequate. Nevertheless, there was little relationship between the recorded levels of care and the health of the patient, and it may have been the standard of recording rather than the care that was inadequate. Measuring plasma digoxin levels in these patients proved to be of little value. Medical audit is thus a useful tool in helping the general practitioner to review his work and improve his knowledge, but it may not be a practical or true way of measuring the quality of care."The correct use of digitalis is a clinical art which can only be learned at the bedside."' Medical audit has been suggested as a method of monitoring the effectiveness and quality of care in general practice, and some possible methods of appraisal have been described.2 Quality control in medicine is being developed in North America for mainly economic reasons and its effect has not yet been evaluated. There is much discussion on this subject in Britain2 3and the assessment of quality is one of the growing points in academic general practice. Acheson4 suggests that any quality control system should be run by the doctors themselves. To be realistic acceptable quality control in general practice must be aimed at a reasonable level of adequate care provided by the doctor, rather than the ideal, and it must be undertaken with as little disturbance of the general practitioner's normal professional activities as possible. ObjectivesThe purpose of this study was to assess the quality of care given to a group of patients on long-term digoxin treatment according to standards suggested by their family doctors, other general practitioners, and a few hospital specialists. Serum digoxin levels were estimated to discover whether this investigation was of value in therapeutic control. The patients were selected for the following reasons: (1) The repeat prescription card system easily identified all patients on digoxin. A disease register was not relied on and the selection method could be used by most doctors. (2) There have been several recent reports of a significant incidence of toxicity in patients on this drug, particularly the elderly, but most published work is hospitaloriented and little is known of the problem in general practice. 5-9 (3) The study group was small and consequently caused little disturbance to normal practice routine. (4) I hoped that criteria for the adequate care ...

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Section: Objectivesmentioning

confidence: 99%

Long-term digoxin treatment in general practice.

Curtis¹

1975

BMJ

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“…The erythrocyte sodium-potassium ion exchange pump was assayed in thirteen pairs by the Rubidiums6 (Rbss) method of Grahame-Smith and Everest (8). Rbss is used in this method as an analog of potassium because of its more favorable half-life, cost, and availability.…”

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confidence: 99%

“…Rbss is used in this method as an analog of potassium because of its more favorable half-life, cost, and availability. Incubations in this assay were performed as described (8) ; the 0.1 ml aliquots of packed cells were incubated at 37' for 2 hr in 2 ml of modified potassiumfree Krebs solution containing a final concentration of 0.37 mM RbssCl (10 pCi) and 5.6 mM glucose. Following incubation the cells were washed three times with 10 ml of iced saline and counted for 10 min in a gamma counter (Nuclear Chicago).…”

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confidence: 99%

Erythrocyte Enigmas in Cystic Fibrosis

Hadden

Hansen

Shapiro

et al. 1973

Experimental Biology and Medicine

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“…; higher concen-trations are accompanied by symptoms of intoxication (Grahame-Smith & Everest, 1969;Lukas, 1971;Godfraind, 1973). Studies on human heart slices have shown that the sodium pump was inhibited by con-0007-1188/79/060175-10 $01.00 centrations equivalent to those found in the blood of the intoxicated patients, whereas the therapeutic concentrations stimulated the activity of the sodium pump (Godfraind, 1972;.…”

Section: Introductionmentioning

confidence: 99%

Stimulation and Inhibition of the Sodium Pump by Cardioactive Steroids in Relation to Their Binding Sites and Their Inotropic Effect on Guinea‐pig Isolated Atria

Ghysel-Burton

Godfraind

1979

British J Pharmacology

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I The actions of ouabain, ouabagenin and dihydroouabain on the contractility and on the ionic content have been investigated in left guinea-pig atria stimulated at 3.3 Hz. The specific binding of ouabain and its displacement by the other cardenolides have been determined. 2 The action of either ouabain or ouabagenin on Na and K content was qualitatively different according to the concentration employed. Low doses evoked a reduction of Nai whereas high doses produced an increase. Dihydroouabain evoked only a Nai gain.3 The increase of KCI concentration from 2.7 to 12 mm decreased Na, in untreated atria and displaced ouabain dose-effect curves to the right.4 ED50 values for the positive inotropic effect were lower than ED50 values for the inhibition of the pump and were not similarly affected by an increase in KCI concentration. 5 The specific binding of ouabain occurred at high and low affinity sites, related to Na pump stimulation and inhibition respectively. 6 The increase in KCI reduced the affinity of the two groups of sites for ouabain and increased the capacity of the high-affinity sites whereas the capacity of the other sites remained unchanged. 7 The results confirm the existence of two specific binding sites for ouabain in guinea-pig heart and suggest that the inhibition of the Na pump is not the only mechanism responsible for the positive inotropic effect of cardiac glycosides.

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Measurement of Digoxin in Plasma and its use in Diagnosis of Digoxin Intoxication

Cited by 94 publications

References 5 publications

Long-term digoxin treatment in general practice.

Long-term digoxin treatment in general practice.

Erythrocyte Enigmas in Cystic Fibrosis

Stimulation and Inhibition of the Sodium Pump by Cardioactive Steroids in Relation to Their Binding Sites and Their Inotropic Effect on Guinea‐pig Isolated Atria

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