Anomalous Serum Digoxin Concentrations in Uremia

When digoxin therapy is discontinued, it is generally assumed that the patient's serum concentration of the drug will decrease over time with a half-life dependent on the rate of digoxin elimination. A few reports (1, 2) have noted deviations from this prediction. We describe a patient with acute renal failure who had an unanticipated twofold rise in his apparent serum concentration of digoxin during the 9 days after the last administered dose of this drug.

A 56-year-old black man with hypertension was hospitalized for atrial fibrillation complicated by embolic small bowel infarction. Several surgical procedures prolonged his hospitalization. An intravenous...