Digoxin-specific Fab fragments as single first-line therapy in digitalis poisoning.

Abstract

OBJECTIVE:

Despite administration of Fab fragments in digitalis poisoning, high mortality rates are consistently reported. A previous study suggested that Fab fragments prescribed as first-line therapy might improve mortality rate. Our objective was to evaluate this approach.

DESIGN:

Retrospective chart review (January 1990 to January 2004).

SETTING:

University hospital intensive care unit.

PATIENTS:

Consecutive patients admitted for cardiac glycoside poisoning.

INTERVENTION:

First-line therapy with Fab fragments (with or without atropine) in either curative or prophylactic doses.

MEASUREMENTS AND MAIN RESULTS:

A total of 141 patients were admitted for digitalis poisoning of whom 66 received first-line Fab fragment therapy. Their median age was 74 years (25th to 75th percentiles: 51-83); 76% were women. Half were intoxicated by digitoxin and half by digoxin. Median serum concentration was 168 (108-205) ng/mL for digitoxin and 6.2 (4.3-13.5) ng/mL for digoxin. Conduction disturbances were reported in 45 cases (68%) and ventricular arrhythmia in six cases (9%). Fab fragments were administered as curative treatment in 21 patients (32%) and prophylactically in 45 patients (68%). The median cumulative dose was 4 (4-6) vials. No adverse effects were reported. Five patients (7.6%) died.

CONCLUSIONS:

First-line therapy with Fab fragments in patients with digitalis poisoning was associated with a low mortality rate.

• Authors: Frédéric Lapostolle, Stephen W Borron, Carine Verdier, Pierre Taboulet, Gilles Guerrier, Frédéric Adnet, Jean-Luc Clemessy, Chantal Bismuth, Frédéric J Baud
• Journal: Critical care medicine (Crit Care Med) Vol. 36 Issue 11 Pg. 3014-8 (Nov 2008) ISSN: 1530-0293 [Electronic] United States
• PMID: 18824911 (Publication Type: Journal Article)

Chemical References

• Cardiotonic Agents
• Digitalis Glycosides
• Immunoglobulin Fab Fragments
• Digoxin
• Atropine
• Digitoxin

Topics

• Aged
• Aged, 80 and over
• Arrhythmias, Cardiac (chemically induced)
• Atropine (administration & dosage)
• Cardiotonic Agents (poisoning)
• Critical Care
• Digitalis Glycosides (immunology, poisoning)
• Digitoxin (poisoning)
• Digoxin (poisoning)
• Female
• Humans
• Immunoglobulin Fab Fragments (administration & dosage, immunology, therapeutic use)
• Male
• Middle Aged
• Poisoning (mortality, prevention & control)
• Retrospective Studies