Sonnenblick M, Abraham A S, Meshulam Z, Eylath U
Br Med J (Clin Res Ed). 1983 Apr 2;286(6371):1089-91. doi: 10.1136/bmj.286.6371.1089.
In 18 patients with gastrointestinal manifestations of digoxin toxicity the mean serum digoxin concentration (+/- SEM) was 3.16 micrograms/l (+/- 0.25), the calcium to potassium ratio 0.31 (+/- 0.01), and the mean arterial pH 7.406 (+/- 0.017). In contrast 19 patients with digoxin induced automaticity had a mean serum digoxin concentration of 1.24 micrograms/l (+/- 0.15; p less than 0.001), a calcium to potassium ratio of 0.38 (+/- 0.01; p less than 0.01), and an arterial pH of 7.498 (+/- 0.008; p less than 0.001). Eight out of 13 patients with digoxin induced cardiotoxicity had serum concentrations of the drug within the therapeutic range (0.8-2.0 micrograms/l). The calcium to potassium ratio, however, was lower than in the patients with automaticity (0.31 +/- 0.02; p less than 0.01) and the arterial pH was 7.370 (+/- 0.033; p less than 0.05). Serum magnesium concentrations were similar in all groups. In this study patients with digoxin induced gastrointestinal symptoms had high serum concentrations of the drug, whereas those with drug induced automaticity had therapeutic concentrations. This second group, however, was identified by their higher calcium to potassium ratios and higher pH values.
18例有地高辛中毒胃肠道表现的患者，其血清地高辛平均浓度（±标准误）为3.16微克/升（±0.25），钙钾比为0.31（±0.01），平均动脉血pH值为7.406（±0.017）。相比之下，19例有地高辛所致自律性异常的患者，其血清地高辛平均浓度为1.24微克/升（±0.15；P<0.001），钙钾比为0.38（±0.01；P<0.01），动脉血pH值为7.498（±0.008；P<0.001）。13例有地高辛所致心脏毒性的患者中，8例药物血清浓度在治疗范围内（0.8 - 2.0微克/升）。然而，其钙钾比低于有自律性异常的患者（0.31±0.02；P<0.01），动脉血pH值为7.370（±0.033；P<0.05）。所有组的血清镁浓度相似。在本研究中，有地高辛所致胃肠道症状的患者药物血清浓度较高，而有药物所致自律性异常的患者药物浓度在治疗范围内。然而，后一组患者的特点是其钙钾比和pH值较高。
