Massive Digoxin Poisoning Treated with Fab Fragments of Digoxin-Specific Antibodies

PEDIATRICS ◽  
1982 ◽  
Vol 70 (3) ◽  
pp. 472-473
Author(s):  
Daniel J. Murphy ◽  
W. Fraser Bremner ◽  
Edgar Haber ◽  
Vincent P. Butler ◽  
Thomas W. Smith ◽  
...  

Acute digoxin poisoning is an uncommon but potentially lethal event in childhood. A case of massive digoxin ingestion and its successful treatment with Fab fragments of digoxin-specific antibodies is described.

1985 ◽  
Vol 14 (2) ◽  
pp. 175-178 ◽  
Author(s):  
Jerrold Leikin ◽  
Stephen Vogel ◽  
Jeffrey Graff ◽  
Robin Goldman-Leikin ◽  
Vincent P Butler ◽  
...  

PEDIATRICS ◽  
1982 ◽  
Vol 70 (3) ◽  
pp. 468-471
Author(s):  
Aaron R. Zucker ◽  
Samuel J. Lacina ◽  
D. S. DasGupta ◽  
H. A. Fozzard ◽  
David Mehlman ◽  
...  

Digitalis poisoning is a rare problem in children, but it may be life threatening. A case of massive overdose of digoxin in a 2½-year-old boy that produced prolonged ventricular fibrillation refractory to conventional therapy is reported. After two hours the boy was given digoxin-specific Fab fragments of antibody in sufficient quantity to bind his estimated dose of 10 mg. By completion of the treatment minutes later, normal rhythm and circulation were restored. The serum free digoxin level before antibody administration was > 100 ng/ml, and it rapidly fell to undetectable levels after antibody was given. Digoxin bound to the antibody had a clearance half-life of approximately 48 hours. The child had no apparent neurologic damage and his intellectual function was normal on discharge. He had a transient hematuria and a residual incomplete right bundle branch block. Administration of purified Fab fragments of digoxin-specific antibodies can be life saving in children with digitalis poisoning, and prolonged cardiopulmonary resuscitation in children is justified when the cause of cardiac arrest is potentially reversible.


1994 ◽  
Vol 13 (8) ◽  
pp. 551-557 ◽  
Author(s):  
Nian Chen ◽  
Mark R. Bowles ◽  
Susan M. Pond

1 The herbicide, paraquat, is accumulated by the energy-dependent polyamine uptake pathway of alveolar type II cells. There it undergoes redox cycling that results in an amplified production of toxic reactive oxygen species and depletion of NADPH and other reducing equivalents. These processes account for the lung being the major target organ for paraquat toxicity. 2 We postulated that paraquat-specific antibodies would inhibit the uptake of the herbicide by type II cells and prevent its toxicity. Accordingly, we examined the effects of paraquat-specific monoclonal antibodies and Fab fragments on the uptake, efflux and cytotoxicity of 50 μM paraquat in suspensions of alveolar type II cells isolated from the rat. 3 The uptake of paraquat was linear over 40 min. Over this time, the uptake rate was inhibited significantly (% inhibition, 73-89) by IgG (25 or 50 μM) or Fab fragments (50 or 100 μM). 4 The apparent efflux rate of paraquat, studied over 16 h, was increased significantly from 0.12 h-1 for the control cells in medium to 0.17 h-1 by paraquat-specific Fab fragments but was unaffected by the specific IgG. 5 Cytotoxicity was determined by measuring the release of 51Cr from the cells. The cytotoxicity of 50 μM paraquat was decreased significantly (percent decrease, 56-80%) in the presence of specific antibodies. 6 These studies in vitro suggest some potential for immunotherapy in selected cases of paraquat poisoning.


2002 ◽  
Vol 25 (6) ◽  
pp. 538-541 ◽  
Author(s):  
P. Chillet ◽  
J.M. Korach ◽  
D. Petitpas ◽  
N. Vincent ◽  
L. Poiron ◽  
...  

Digoxin-specific antibodies (Fab) are currently the treatment of choice for digoxin intoxication. These fragments bind to digoxin, leading to Fab-digoxin complexes, and promote the release of receptor-bound digoxin. These complexes are renally excreted. In the case of anuria, they could be dissociated and lead to renewed intoxication. In this case plasma exchanges are proposed. We report the case of an anuric patient with digoxin intoxication, treated with a Fab injection, followed by a plasma exchange 16 hours later, a second Fab injection was given followed by two plasma exchanges, 38 and 86 hours later. The disappearance of cardiac abnormalities showed the efficiency of the Fab, the drop in serum digoxin concentration and the high digoxin concentration in the exchanged plasma indicate effective elimination. The association of Fab and plasma exchanges could be proposed in the case of digoxin intoxication in the anuric patient.


1985 ◽  
Vol 6 (2) ◽  
pp. 91-93 ◽  
Author(s):  
Salvatore Presti ◽  
Deborah Friedman ◽  
Judy Saslow ◽  
Eugenie F. Doyle ◽  
Vincent P. Butler ◽  
...  

Author(s):  
Frédéric Lapostolle ◽  
Stephen W. Borron

Despite a gradual decline in the clinical use of digitalis glycosides, digitalis toxicity continues to be responsible for substantial morbidity and mortality, particularly among the elderly. Digitalis poisoning may occur acutely, after intentional overdose, but is more often seen as the result of chronic intoxication among patients receiving digitalis therapy. Clinical findings in chronic digitalis poisoning are often subtle. The astute clinician will enquire about digitalis use in older patients with vague complaints and will not be dissuaded from considering digitalis toxicity in the face of a ‘therapeutic’ digitalis blood concentration. Two digitalis preparations continue to be used with frequency, depending on geography. Digoxin is the digitalis glycoside of choice in the USA, while digitoxin prevails in some parts of Europe. While the methods and half-lives of elimination differ markedly for these two substances, the approach to poisoning by either is similar. Advanced age, underlying cardiovascular disease, and severe hyperkalaemia represent poor prognostic factors in digitalis poisoning. Early administration of digitalis Fab fragments should be undertaken when life-threatening symptoms are present. Prophylactic therapy with reduced doses of Fab fragments should be strongly considered for less serious toxicity.


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