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Digoxin, magnesium, and potassium levels in a forensic autopsy material of sudden death from ischemic heart disease

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Summary

In 91 cases where the cause of death was heart disease, digoxin, Mg and K concentrations in serum and ventricular myocardium were measured post mortem. Forty per cent were positive for digoxin in both serum and myocardium. The mean serum level was 5.1±2.4 nmol/l and the mean myocardial level was 42.6±27.5 ng/g. Correlation could be established between serum and myocardial concentrations of digoxin. There were statistically significant differences in serum as well as in myocardial digoxin levels in persons on 0.13 mg and 0.25 mg per day, respectively. Myocardial levels of Mg and K were low as generally found in persons with ischemic heart disease. There was no correlation between these levels and myocardial digoxin concentrations. Caution must be exercised in the assessment of digoxin results from cadaver samples because of the postmortem rise of digoxin serum concentrations. Considering this fact, the results still indicate that the prevalence of toxic digoxin concentrations might be more common than previously thought.

Zusammenfassung

In 91 Obduktionsfällen, bei denen der Tod die Folge von Herzkrankheiten war, fand sich Digoxin in 40% der Fälle sowohl im „Blutserum“ als auch im Myocard. Die durchschnittliche Konzentration war 5,5±2,4 nmol/l im Serum und 42,6±27,5 ng/g im Myocard. Es bestand eine Korrelation zwischen den Konzentrationen im Serum und im Myocard. Bei Personen, die 0,13 mg resp. 0,25 mg Digoxin täglich eingenommen hatten, lagen statistisch signifikante Unterschiede sowohl bezüglich der Serum- als auch Myocard-Digoxin-Konzentration vor. Die Mg- und K-Konzentrationen im Myocard waren niedrig, wie dies im allgemeinen bei Personen mit ischämischen Herzkrankheiten der Fall ist. Bei der Beurteilung der Resultate von Untersuchungen auf Digoxin in Leichenteilen muß beachtet werden, daß die Konzentration des Digoxin im Serum postmortal steigen kann. Selbst wenn dies berücksichtigt wird, deuten die Untersuchungsresultate darauf hin, daß toxische Digoxinkonzentrationen bei Personen, die unerwartet infolge von Herzkrankheiten verstorben sind, häufiger vorkommen als bisher angenommen wurde.

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Authors and Affiliations

  1. Department of Forensic Medicine, University of Lund, Sölvegatan 25, S-22362, Lund, Sweden

    A. Ottosson & P. Löwenhielm

  2. Department of Pharmacology, University of Lund, Sölvegatan 25, S-22362, Lund, Sweden

    L. Edvinsson

  3. Department of Internal Medicine, University of Lund, Sölvegatan 25, S-22362, Lund, Sweden

    L. Edvinsson & A. Sjögren

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  1. A. Ottosson
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  2. L. Edvinsson
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  3. A. Sjögren
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  4. P. Löwenhielm
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Ottosson, A., Edvinsson, L., Sjögren, A. et al. Digoxin, magnesium, and potassium levels in a forensic autopsy material of sudden death from ischemic heart disease. Z Rechtsmed 101, 27–36 (1988). https://doi.org/10.1007/BF00205321

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  • DOI: https://doi.org/10.1007/BF00205321

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