title: Free and total digoxin in serum during treatment of acute digoxin poisoning with Fab fragments: case study.
abstract: A woman ingested 10 mg of methyldigoxin in a suicide attempt and presented 19 hours after ingestion with clinical signs of glycoside intoxication. Her serum level of digoxin was 7.4 ng/mL, and antidotal therapy with Fab antibody fragments was started. The manufacturer's recommended dosing scheme was modified, with 80 mg Fab administered intravenously within 15 minutes followed by a continuous infusion at 30 mg/h. Total serum concentration of digoxin increased markedly within minutes after Fab therapy was started, while the level of free digoxin immediately decreased into the nontoxic range without recrudescent toxic effects of digoxin. The cumulative amounts of free and bound digoxin that were excreted in urine within 30 hours after ingestion were 900 microg and 1600 microg, respectively. Half-life of bound digoxin in urine was 9.9 hours; mean rate of clearance of bound digoxin in the urine was 7.0 mL/min. On the basis of these kinetic data, a smaller initial bolus dose of Fab followed by a continuous infusion may be a more tailored, cost-effective, and relatively safe therapy for patients who have overdosed on cardiac glycosides.
authors.affiliation: Department of Clinical Toxicology at Technische Universität, Munich, Germany. Florian.Eyer@t-online.de
authors.forename: Florian
authors.initials: F
authors.lastname: Eyer
authors.forename: Werner
authors.initials: W
authors.lastname: Steimer
authors.forename: Christine
authors.initials: C
authors.lastname: Müller
authors.forename: Thomas
authors.initials: T
authors.lastname: Zilker
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000097:blood / Q000506:poisoning*; D004077:Digoxin / Q000097:blood*; D005260:Female; D006207:Half-Life; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000627:therapeutic use*; D008520:Medigoxin / Q000097:blood / Q000506:poisoning*; D013406:Suicide, Attempted
chemical_list: D000889:Anti-Arrhythmia Agents; D007140:Immunoglobulin Fab Fragments; D004077:Digoxin; D008520:Medigoxin