title: Digoxin specific antibody (Fab) fragments in 34 cases of severe digitalis intoxication.
abstract: 34 patients aged between 2 and 80 years were treated with digoxin specific antibody (Fab) fragments for severe digitalis poisoning. In 27 cases, the glycoside was taken with suicidal intent; in 3 cases accidentally and 4 were iatrogenic. The following criteria were considered to be indications for use of Fab fragments: the appearance of life-threatening arrhythmias such as high-grade atrioventricular conduction disorders (grade 2 and 3 A-V block), multifocal ectopic beats, ventricular tachycardia, and relapsing ventricular fibrillation. Serum digoxin concentrations were between 3.4 and 29ng/ml before the start of treatment. Between 240 and 800mg of Fab were administered; the majority of patients received 480mg. Regression of arrhythmias was seen between 0.5 and 8 hours after Fab infusion. There was a rapid fall in the free digoxin in the serum to concentrations that were no longer measurable and a marked rise in bound digoxin with a simultaneous increase of excretion of bound digoxin in the urine. Fab therapy is considered to be a major advance in the treatment of severe, previously fatal, glycoside poisoning. No notable side effects or allergic reactions were observed.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000918:Antibody Specificity; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004071:Digitalis Glycosides / Q000506:poisoning*; D004077:Digoxin / Q000097:blood / Q000276:immunology* / Q000652:urine; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments; D007700:Kinetics; D008297:Male; D008875:Middle Aged
chemical_list: D004071:Digitalis Glycosides; D007140:Immunoglobulin Fab Fragments; D004077:Digoxin