Interrelation between Potassium Metabolism and Digitalis Toxicity in Heart Failure.

Abstract

Summary and Conclusion1. In a series of patients in congestive failure, potassium depletion, either occurring spontaneously with malnutrition and gastrointestinal disorders or induced by mercurial diuresis after pre-treatment with ammonium chloride, was found to be associated with increased sensitivity to digitalis. 2. In 2 patients a similar decreased threshold of digitalis toxicity was observed after daily doses of 20 mg of desoxycorticosterone acetate for 4 to 10 days. 3. In one digitalized patient, digitalis toxicity was precipitated by intravenous injection of insulin and glucose, which was followed by the development of hypokalemia. 4. It is suggested that this increased myocardial sensitivity to digitalis probably results from alterations in intracellular potassium distribution since no significant changes in serum (or extracellular) potassium were observed in 8 of 10 patients.The authors gratefully acknowledge the advice and interest of Dr. Louis Leiter, and the technical assistance of Mr. George ...