Acute digoxin overdose in a newborn with renal failure: use of digoxin immune Fab and peritoneal dialysis.
Digitalis intoxication is a common problem, mainly because of the narrow margin of safety of digoxin. These patients may have concomitant renal failure. In patients who have renal failure and who have been treated with digoxin-Fab, the elimination of the digoxin-Fab complex is significantly delayed, and there is a risk of dissociation of the complex with rebound of free digoxin and recurrence of toxicity. The high molecular weight of digoxin and digoxin-Fab complex prevents its elimination by hemodialysis or continuous arteriovenous hemofiltration. A 3-day-old newborn with digoxin overdose and acute renal failure was treated with digoxin immune Fab and peritoneal dialysis. Low levels of total digoxin were measured in the dialyzate, indicating poor elimination of the digoxin-Fab complex through peritoneal dialysis.
Division of Clinical Pharmacology, Hospital for Sick Children, Toronto, Ontario, Canada.
M
M
Berkovitch
M R
MR
Akilesh
R
R
Gerace
Z
Z
Verjee
M
M
McGuigan
H
H
Whyte
G
G
Koren
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000378:metabolism* / Q000628:therapy*; D000328:Adult; D002648:Child; D004077:Digoxin / Q000506:poisoning*; D062787:Drug Overdose / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000378:metabolism* / Q000627:therapeutic use*; D007231:Infant, Newborn; D010530:Peritoneal Dialysis; D011247:Pregnancy
D007140:Immunoglobulin Fab Fragments; C050199:digoxin antibodies Fab fragments; D004077:Digoxin