Related Experiment Video
Updated: May 12, 2026
07:27
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Severe suicidal digoxin toxicity managed with resin hemoperfusion: A case report.
Deven Juneja1, Omender Singh, Alka Bhasin
1Department of Critical Care Medicine and Nephrology, Max Super Speciality Hospital, New Delhi, India.
Summary
Severe digoxin toxicity, often intentional, can be life-threatening. In resource-limited settings without digoxin-specific antibody (Fab) fragments, resin hemoperfusion offers an effective alternative for managing digoxin poisoning.
Area of Science:
- Toxicology
- Cardiology
- Nephrology
Background:
- Digoxin toxicity poses a significant public health risk due to the drug's availability and abuse potential.
- Digoxin-specific antibody (Fab) fragments are the standard treatment for severe digoxin toxicity, but cost and availability are limitations, especially in developing countries.
- Alternative management strategies are crucial for severe digoxin intoxications where Fab fragments are inaccessible.
Observation:
- A young female presented with a history of ingesting a large dose of digoxin (17.5 mg).
- She developed severe complications including atrioventricular blocks and hemodynamic instability, requiring temporary pacemaker insertion.
- Her serum digoxin level was critically high at 12.63 ng/ml.
Findings:
- In the absence of digoxin-specific antibody (Fab) fragments, resin hemoperfusion was employed as an alternative treatment.
- Hemoperfusion led to a significant reduction in serum digoxin levels.
- The patient's symptoms and hemodynamic instability were successfully reversed following hemoperfusion.
Implications:
- Resin hemoperfusion is a viable and effective alternative for managing severe digoxin toxicity when Fab fragments are unavailable.
- This case highlights the importance of considering alternative treatments in resource-limited settings for managing poisoning cases.
- Exploring and validating alternative therapies can improve outcomes for patients with digoxin poisoning globally.
Related Concept Videos
01:25Extracorporeal Removal of Drugs: Hemoperfusion and Hemofiltration
Hemoperfusion and hemofiltration are critical techniques in medical treatments to eliminate accumulated drugs, metabolites, and electrolytes from the bloodstream. These methods are particularly vital in cases of accidental poisoning and drug overdose.Hemoperfusion involves passing blood through an adsorbent material to remove unwanted substances. The main adsorbents used in hemoperfusion include activated charcoal and Amberlite resins. Activated charcoal can adsorb both polar and nonpolar...
01:26Heart Failure Drugs: Inotropic Agents
Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
01:30Cardiomyopathy II: Dilated Cardiomyopathy
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
01:26Pharmaceutical Poisoning: Treatment Strategies
Treatment strategies for poisoning are a critical aspect of emergency medicine, focusing on preventing the absorption of toxins and enhancing their elimination. When a poisoning incident occurs, the first response is to halt exposure and decontaminate the patient, particularly through gastrointestinal (GI) methods if the poison was ingested.Gastrointestinal Decontamination Techniques:Activated charcoal is the cornerstone of GI decontamination. It works through adsorption, binding the toxin to...
01:30Heart Failure V: Medical Management
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
01:30Extracorporeal Removal of Drugs: Peritoneal Dialysis and Hemodialysis
Patients with end-stage renal disease (ESRD) or those experiencing drug overdose often require extracorporeal methods to eliminate accumulated drugs and metabolites. Hemoperfusion, hemofiltration, and dialysis are the primary techniques to rapidly remove harmful substances without disrupting the patient's fluid and electrolyte balance. For those with compromised renal function, dosage adjustments of concurrent medications may be necessary during extracorporeal drug removal.Dialysis is a process...