Does the development of hypokalemia and potassium loss induce cardiac arrhythmias in heart failure patients on maintenance digoxin therapy?
Hypokalemia and potassium loss can precipitate cardiac arrhythmias mimicking digoxin toxicity in heart failure patients, even when serum digoxin concentrations remain normal.
Twelve patients with congestive heart failure receiving maintenance therapy with digoxin and potent diuretics were followed closely during development of hypokalemia and potassium loss. Cardiac arrhythmias compatible with digoxtin toxicity developed in 6 patients in the presence of stable, normal serum digoxin concentrations. The mechanisms involved in the development of the rhythm disturbances are discussed with regard to hypokalaemia, intracellular potassium loss, intra-/extracellular potassium gradients and digoxin, and the significance of maintaining a normal potassium balance in this setting is stressed.
Steiness et al. (Sun,) studied this question.