[Digitalis intoxication during the neonatal period: role of dehydration].
BACKGROUND
Despite the great progress which has been made in the treatment of acute digitalis intoxication by digoxin-immune Fab, it still remains a severe complication of cardiotonic therapy.


METHODS
A neonate with ventricular septal defect and large left-to-right shunt was treated with digitalis and diuretics at the usual starting doses. An intensive phototherapy was also required because of a hyperbilirubinemia due to glucose-6-phosphate dehydrogenase deficiency. Toxic digoxin accumulation (plasma level 14 ng/mL) was diagnosed three days after the initiation of treatment by the presence of sinus bradycardia and bursts of ventricular fibrillation. Intravenous administration of digoxin-specific antibody Fab fragments (Digidot) was effective, with a rapid improvement of the digitalis poisoning.


CONCLUSIONS
Because of the particularities concerning drug distribution, metabolism and elimination of drugs in the neonatal period, the digoxin therapeutic index is narrow. This case report suggests the involvement of phototherapy and diuretics, which might induce a significant decrease in extracellular water and drug distribution volumes, ultimately promoting the occurrence of an intoxication.
Service de réanimation néonatale et pédiatrique, CHU de Montpellier, France.
G
G
Cambonie
K
K
an Haack
G
G
Guyon
M
M
Badr
S
S
Fournier-Favre
I
I
Souksi
S
S
Guillaumont
D002316:Cardiotonic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003681:Dehydration; D004071:Digitalis Glycosides / Q000009:adverse effects* / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use*; D006345:Heart Septal Defects, Ventricular / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010789:Phototherapy
D002316:Cardiotonic Agents; D004071:Digitalis Glycosides; D004232:Diuretics