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Digoxin-specific Fab fragments in the treatment of oleander toxicity in a canine model
R F Clark1, B S Selden, S C Curry
1Department of Medical Toxicology, Good Samaritan Regional Medical Center, Phoenix, Arizona.
Study Objective:
To examine the efficacy of digoxin-specific Fab fragments (dsFab) in the treatment of experimentally induced Nerium oleander cardiac glycoside toxicity in a dog model.
Design:
A nonblined, placebo-controlled experiment.
Subjects:
Ten adult greyhound dogs of either sex divided into treatment and control groups of five dogs each.
Interventions:
A tincture of oleander was prepared and administered intravenously to each animal. After the onset of cardiotoxicity, the treatment group received 60 mg/kg dsFab IV.
Measurements And Main Results:
All dogs exhibited dysrhythmias meeting our criteria for cardiac glycoside cardiotoxicity within 27 minutes of beginning the infusion. Three of five control dogs had lethal dysrhythmias during the three-hour observation period. The remaining two control dogs exhibited dysrhythmias throughout the three-hour experiment. All five of the dsFab-treated dogs survived and converted to normal sinus rhythm within eight minutes of dsFab infusion. Three treatment animals reverted back to nonlethal and hemodynamically stable dysrhythmias after a mean of 107 minutes.
Conclusion:
Large doses of dsFab are efficacious in the treatment of dysrhythmias in this canine model of N oleander cardiac glycoside poisoning.