Grand RoundsUtility of Physiologically Based Pharmacokinetic Modeling in Point-of-Care Decisions An Example Using Digoxin Dosing in Continuous Venovenous HemodiafiltrationSrinivasan, Meenakshi PharmD*; Hirani, Raiz DO†; Tsiu, Melissa PharmD‡; Kabani, Khadija DO‡; Chaturvedula, Ayyappa PhD, FCP*; Palasik, Brittany PharmD, BCPS*Author Information *University of North Texas System College of Pharmacy, Fort Worth, Texas; †Parkland Hospital, Dallas, Texas; and ‡Methodist Charlton Medical Center, Dallas, Texas. Correspondence: Brittany Palasik, PharmD, BCPS, University of North Texas System College of Pharmacy, 3500 Camp Bowie Boulevard-RES 435H, Fort Worth, TX 76107 (e-mail: email@example.com). M. Srinivasan, A. Chaturvedula, and B. Palasik were involved in the conception and design of the study. M. Tsiu and B. Palasik were involved in data collection and patient management. R. Hirani, K. Kabani, B. Palasik, and M. Tsiu were involved in patient management. M. Srinivasan and A. Chaturvedula were involved in modeling and interpretation. M. Srinivasan, A. Chaturvedula, and B. Palasik were involved in drafting the article. M. Srinivasan, R. Hirani, M. Tsiu, K. Kabani, A. Chaturvedula, and B. Palasik were involved in critical revision of the article. The authors declare no conflict of interest. All procedures performed in this case report were in accordance with the ethical standards of the institution and were approved by the North Texas Institutional Review Board, in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.drug-monitoring.com). Received June 10, 2019 Accepted August 24, 2019 Therapeutic Drug Monitoring: February 2020 - Volume 42 - Issue 1 - p 1–5 doi: 10.1097/FTD.0000000000000704 Buy SDC Metrics Abstract Abstract: We describe the case of a patient on continuous venovenous hemodiafiltration with atrial fibrillation with rapid ventricular response and hypotension requiring vasopressor use, which warranted digoxin therapy. In the absence of guidelines specifying appropriate digoxin dosing in patients undergoing continuous venovenous hemodiafiltration, anecdotal evidence-guided digoxin dosing was performed for this patient using plasma digoxin concentration-based therapeutic drug monitoring. We use this case to demonstrate the potential role of physiologically based pharmacokinetic modeling in assisting therapeutic decision making. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.