DLIS Concentrations and Therapeutic Range of Digoxin

The issue of interference of DLIS in serum digoxin measurement depends on the choice of immunoassay. If the FPIA (Abbott Laboratories) assay is used for the determination of serum digoxin concentrations, the interference of DLIS may be significant in volume-expanded patients. Miller et al. (30) reported a DLIS concentration of 0.88 ng/mL in a patient who never took digoxin. A DLIS concentration of 1.15 ng/mL in another patient with liver failure had also been reported (31). Logoglu et al. used an RIA (double antibody RIA) for detecting DLIS in sera of patients with normal and preeclamptic pregnancies. The mean DLIS concentration in the normotensive group (n = 14) was 0.29 ng/mL, whereas the mean was 0.31 ng/mL in the preeclamptic group (n = 17). The authors concluded that there was no statistical difference between DLIS concentrations in these two groups (32). Doolittle et al. (33) described a case where a residual level of 1.0 ng/mL of digoxin was observed for 11 days in a patient despite no digoxin being administered. Garbagnati measured DLIS concentrations in children (age: 5-16 years) using a FPIA digoxin assay. The authors observed measurable DLIS concentrations in 50% of the children (range 0.03-0.35 ng/mL) (34).

Lusic et al. reported comparable plasma and cerebrospinal fluid levels (CSF) of DLIS in 40 patients diagnosed with aneurysmal subarachnoid hemorrhage. On the first day, DLIS concentrations were detected in sera of 34 patients (range: 0-0.86 ng/mL,) and CSF of 32 patients (range: 0-1.01 ng/mL). On the seventh day post hemorrhage, DLIS were present in plasma of 37 patients (range: 0-1.52 ng/mL) and in CSF of 38 patients (range: 0-1.67 ng/mL). The authors used an FPIA (Digoxin II, Abbott Laboratories) for their study (35).

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