Evaluation of Different Methods for Determining Serum Concentrations of Cardiac Glycosides
Two centuries have passed since Withering first reported that digitalis “has a power over the motion of the heart, to a degree yet unobserved in any other medicine” (Withering, 1937). Although digitalis glycosides are now widely used in the therapy of congestive heart failure, the dosage of digitalis preparations must, as in Withering’s day, be carefully adjusted to the needs of each individual patient in order that an optimal therapeutic effect may be achieved without the development of toxic side-effects because, as Withering noted, excessive digitalis “occasions sickness, vomiting. purging, giddiness, confused vision, objects appearing green or yellow ... slow pulse ... cold sweats, convulsions, syncope, death” (Withering, 1937). Developments in the first 6 decades of this Century which have enhanced the physician’s ability to adjust digitalis dosages to the specific needs of individual patients have included: the isolation of highly purified cardenolides, the recognition of the effects of digitalis on the electrocardiogram, a better definition of the effects of cardiac glycosides on myocardial contractility, conduction, and automaticity, and an appreciation of the role of electrolyte disturbances in facilitating the development of digitalis toxicity (Butler, 1972).
KeywordsToluene Dichloromethane Anhydride Charcoal Cardiol
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