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Digoxin Immune Fab Therapy for Digoxin Toxicity
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
The interesting observational study by Ujhelyi and colleagues [1] showing “rebound” toxicity after the use of digoxin immune Fab fragments raised some important concerns. The clinical features of acute and chronic digitalis toxicity differ substantially. Pharmacologically, it would have been better to separate the two groups. The timing of the last doses of digoxin before blood sampling is unclear, as is the possible effect of ingesting other drugs. Further, the serum creatinine levels in the 14 patients ranged widely from normal to markedly abnormal; thus, creatinine clearances should have been compared in the group with chronic digitalis intoxication.
Because of potential interference by digoxin-like immunoreactive substance, well known to be elevated in patients with renal failure [2, 3] and many other conditions [4], the assay methods should have been similar for all patients. Three assay methods were used by the authors to measure total digoxin and free digoxin, depending on the study site. In a study of 10 methods of digoxin measurement (including those used in this study), Morris and colleagues [5] found a wide range in the interference by digoxin-like immunoreactive substance.
Scott D. Phillips, MD
Rocky Mountain Poison Center; University of Colorado Health Sciences Center; Denver, CO 80204
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
