Severe digoxin intoxication in a child treated by infusion of digoxin-specific Fab-antibody-fragments.
Accidental digitalis ingestion in children is a rare, but potentially life-threatening emergency. We report the case of a 2 10/12-year-old boy with accidental ingestion of 6 mg beta-Acetyl-digoxin. Soon after admission, the boy developed sinus bradycardia, SA and AV-block, of increasing severity without circulatory impairment. As the serum digoxin level reached 21.7 ng/ml digoxin-specific Fab-antibody-fragments were used to bind free serum digoxin. Immediately after infusion, serum free digoxin was below the detection limit, whereas total digoxin peaked at 219 ng/ml 5 h thereafter. The arrhythmias did not subside totally, so that in addition, a transvenous pacemaker was placed, but never used. The antibody-infusion was well tolerated and the boy was discharged in good health.
D000113:Acetyldigoxins / Q000506:poisoning*; D001146:Arrhythmia, Sinus / Q000628:therapy*; D002675:Child, Preschool; D004077:Digoxin / Q000031:analogs & derivatives* / Q000097:blood / Q000276:immunology*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male
D000113:Acetyldigoxins; D007140:Immunoglobulin Fab Fragments; D004077:Digoxin