title: Immediate control of life-threatening digoxin intoxication in a child by use of digoxin-specific antibody fragments (Fab).
abstract: Digoxin-immune antibody fragments (Fab) for treatment of digitalis intoxication was introduced in 1976. Many reports have been published concerning this therapy for children, but few have focused on its immediate reversal of cardiac as well as extracardiac life-threatening manifestations of digoxin toxicity. We present a case of life-threatening digitalis intoxication in a child with postoperative renal insufficiency, after a Sennings procedure for transposition of the great arteries. Digoxin administration according to the nationally recommended dosage and intervals unexpectedly resulted in serum levels in the toxic range. Severe cardiac arrhythmias, haemodynamic instability and a rapid-increasing serum potassium level resulted. This report demonstrates how administration of Fab according to the manufacturer's dosage recommendation reversed the tachyarrhythmia immediately and re-established a normal level of serum potassium within minutes.
authors.affiliation: Department of Anesthesia and Intensive Care, University of Bergen, Haukeland University Hospital, 5021 Bergen, Norway. paul.husby@kir.uib.no
authors.forename: P
authors.initials: P
authors.lastname: Husby
authors.forename: M
authors.initials: M
authors.lastname: Farstad
authors.forename: J G
authors.initials: JG
authors.lastname: Brock-Utne
authors.forename: M E
authors.initials: ME
authors.lastname: Koller
authors.forename: L
authors.initials: L
authors.lastname: Segadal
authors.forename: T
authors.initials: T
authors.lastname: Lund
authors.forename: O J
authors.initials: OJ
authors.lastname: Ohm
mesh_terms: D019138:Antibodies, Blocking / Q000627:therapeutic use*; D000918:Antibody Specificity; D006348:Cardiac Surgical Procedures; D002316:Cardiotonic Agents / Q000009:adverse effects* / Q000037:antagonists & inhibitors* / Q000276:immunology; D004077:Digoxin / Q000009:adverse effects* / Q000037:antagonists & inhibitors* / Q000276:immunology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000188:drug therapy / Q000209:etiology; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D007223:Infant; D011183:Postoperative Complications / Q000139:chemically induced* / Q000188:drug therapy*; D011188:Potassium / Q000097:blood; D014188:Transposition of Great Vessels / Q000601:surgery
chemical_list: D019138:Antibodies, Blocking; D002316:Cardiotonic Agents; D007140:Immunoglobulin Fab Fragments; D004077:Digoxin; D011188:Potassium