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Limitations of Hemofiltration in Digoxin Overdose

Kenneth Conrad, MD
Arch Intern Med. 1986;146(11):2287. doi:10.1001/archinte.1986.00360230233036.
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To the Editor.  —I was amazed to read the article by Lai et al entitled "Hemofiltration in Digoxin Overdose" that appeared in the June 1986 issue of the Archives.1 Lai and coworkers concluded that hemofiltration was associated with a fall in digoxin levels in the patient they studied. Lai and coworkers implied that the procedure produced an important increase in digoxin clearance. This is not the case.The authors reported a digoxin removal rate of 20 ng/min. This is equivalent to the removal of 1200 ng or 1.2 μg/h. If this removal rate persisted for 20 hours, 24 μg or 0.024 mg would be removed. The authors did not report the patient's digoxin dose, but if he received 0.25 mg/d, this invasive procedure would amount to the removal of 1/10 tablet! Even if the hemofiltration rate could be increased to 300 mL/min and the digoxin level were 5 ng/mL


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