CASE STUDY 30.1 A patient with congestive heart failure has been successfully tr

Question

CASE STUDY 30.1 A patient with congestive heart failure has been successfully treated with digoxin for several years, but recently developed renal failure. Laboratory records indi- cate semiannual peak digoxin concentrations that have all been within the therapeutic range. A serum specimen was collected upon admission and results are shown in the ase Study Table 30.1.1. Although the digoxin concentration is elevated, the physician indicates the patient is not exhibiting signs or symptoms of toxicity CASE STUDY TABLE 30.1.1 Laboratory Results Test Sodium Potassium Chloride Blood pH tCO2 Urea nitrogen 180 Creatinine Osmolality Digoxin Reference Interval 135-145 mmol/L 3.5-5 mmo/L 97-107 mmol/L 7.35-7.45 21-31 mmol/L 5-20 mg/dlL 0.6-1 mg/dL 282-300 mOsm/kg 0.9-2 ng/mL Result 129 5.5 113 7.25 16 4.5 275 2.5 Questions 1. If the specimen was collected without consideration of the time of the patient's last digoxin dose, how might this affect the interpretation of the result? 2. Other than the time relative to dose administration, what additional factors should be taken into consideration when interpreting the digoxin result? 3. What additional laboratory test would aid in the interpretation of this case?

Explanation / Answer

1. The timing of sampling the serum is also very important. If the sample is drawn before the drug is completely distributed in the body, then the results show higher concentration in serum. After 2-3 hours thr serum drug levels show high peak.Usually the blood sample should be drawn just before the next drug dose with few exceptions.

.2. Other than time related factors for the given medicine dose administration, age is also one of the main criteria that should be taken into consideration. Also the patient might have had rapid atrial fibrillation that should be treated with little higher dose of digoxin, which might have shown the above results.So state of the disease is also important.

3.An ultrasound or computerised tomography could be done for scanning any abnormalities in kidneys.

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