Massive ingestion of cardiac drugs: toxicokinetic aspects of digoxin and sotalol during hemofiltration

Abstract

Case. We present the case of a 75-year-old patient admitted to the emergency department after ingesting a large amount of several cardiac drugs, among which were digoxin and sotalol. Because of renal insufficiency, cardiogenic shock, and high serum digoxin levels, the patient received continuous venovenous hemofiltration (CVVH) and digoxin-specific Fab fragments. Digoxin and the digoxin-specific Fab fragments are normally cleared by the kidneys. Methods. Serum-free and total digoxin and serum sotalol concentrations were monitored for several days. Results. Less than 10% of the estimated ingested dose of digoxin was cleared by CVVH within 5 days. Conclusion.  CVVH has little influence on the clearance of Fab-bound digoxin from the body. In contrast, sotalol is efficiently cleared by CVVH.

Keywords:

• Digoxin-specific Fab fragments
• Autointoxication
• Sotalol overdose
• Digoxin overdose