Summary
A 20-month-old girl with massive digitoxin intoxication (initial digitoxin serum level: 629 ng/ml) was successfully treated with digoxin-specific antibody fragments (Fab). She presented with moderate signs of digitalis toxicity (somnolence, bradycardia, first-degree AV block) and improved rapidly during fractional Fab administration. Free serum-digitoxin disappeared after 6 vials of Fab (480 mg), but was measurable again on days 6 and 7. This case demonstrated that digoxin-specific antibodies, despite a 30–100 times lesser affinity for digitoxin, are effective in massive digitoxin intoxications. A rebound phenomenon may occur several days later and should be taken into consideration.
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Antman EM, Wenger TL, Butler VB Jr, Haber E, Smith TW (1990) Treatment of 150 cases of life-threatening digitalis intoxications with digoxin specific Fab antibody fragments. Final report of a multicenter study.Circulation 81:1744–1752
Bismuth C, Gaultier F, Conso F, Efthymiou ML (1973) Hyperkalemia in acute digitalis poisoning: prognostic significance and therapeutic implications.Clin Toxicol 6:153–162
Lewander WJ, Gaudreault P, Einhorn A, Henretig FM, Lacouture PG, Lovejoy FH Jr (1986) Acute pediatric digoxin ingestion. A ten year experience.Am J Dis Child 140:770–773
Smith TW, Butler VP Jr, Haber E (1970) Characterisation of antibodies of high affinity and specifity for the digitalis glycoside digoxin.Biochemistry 9:331–337
Smolarz A, Abshagen U (1985) Immunpharmakologische Behandlung von 9 Digitalisvergiftungen bei Kindern mit Schaf-Antidigoxin Fab.Monatsschrift Kinderheilkd 133:682–687
Smolarz A, Abshagen U (1986) Digitalis Antikörper Fragmente (Fab) bei 90 schweren Glykosidvergiftungen. Klinische Erfahrungen aus einer multizentrischen Studie.Herz Kreis 18:261–266
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Schmitt, K., Tulzer, G., Häckel, F. et al. Massive digitoxin intoxication treated with digoxin-specific antibodies in a child. Pediatr Cardiol 15, 48–49 (1994). https://doi.org/10.1007/BF00797008
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DOI: https://doi.org/10.1007/BF00797008