Massive digitoxin intoxication treated with digoxin-specific antibodies in a child.
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.
Schmitt
K
K
Children's Hospital of Linz, Austria.
Tulzer
G
G
Häckel
F
F
Sommer
R
R
Tulzer
W
W
D004074:Digitoxin / Q000276:immunology / Q000493:pharmacokinetics / Q000506:poisoning*; D062787:Drug Overdose / Q000097:blood / Q000628:therapy*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006327:Heart Block / Q000097:blood / Q000139:chemically induced / Q000628:therapy; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D007223:Infant; D007262:Infusions, Intravenous; D009460:Neurologic Examination / Q000187:drug effects
D007140:Immunoglobulin Fab Fragments; C050199:digoxin antibodies Fab fragments; D004074:Digitoxin