title: Massive digitoxin intoxication treated with digoxin-specific antibodies in a child.
abstract: 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.
authors.affiliation: Children's Hospital of Linz, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Schmitt
authors.forename: G
authors.initials: G
authors.lastname: Tulzer
authors.forename: F
authors.initials: F
authors.lastname: Häckel
authors.forename: R
authors.initials: R
authors.lastname: Sommer
authors.forename: W
authors.initials: W
authors.lastname: Tulzer
mesh_terms: 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
chemical_list: D007140:Immunoglobulin Fab Fragments; C050199:digoxin antibodies Fab fragments; D004074:Digitoxin