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Use of digoxin Fab immune fragments in a seven-day-old infant
J Kaufman1, J Leikin, D Kendzierski
1Department of Pediatrics, College of Medicine, University of Illinois, Chicago.
Insights
Digoxin immune Fab effectively treated digoxin poisoning in a neonate. Close glucose monitoring is crucial due to potential hypoglycemia following treatment.
Area of Science:
- Pediatric Cardiology
- Clinical Toxicology
- Neonatal Medicine
Background:
- Digoxin is used for paroxysmal supraventricular tachycardia (PSVT) in neonates.
- Medication errors can lead to digoxin toxicity, even in young infants.
- Digoxin immune Fab is a potential antidote for severe digoxin poisoning.
Observation:
- A seven-day-old neonate received a digoxin overdose due to a dispensing error.
- The neonate presented with digoxin toxicity and was treated with digoxin immune Fab.
- Transient hypoglycemia occurred 13-22 hours post-infusion.
Findings:
- Digoxin immune Fab successfully reversed the effects of digoxin overdose.
- The patient experienced transient hypoglycemia (43-52 mg/dl) post-treatment.
- Hypoglycemia resolved with glucose supplementation and adjusted feedings.
Implications:
- Digoxin immune Fab is a viable treatment for neonatal digoxin poisoning.
- Close monitoring for electrolyte shifts, particularly hypoglycemia, is essential after digoxin immune Fab administration in neonates.
- This case highlights the importance of medication safety protocols in neonatal care.
Abstract:
We report the use of digoxin immune Fab in a seven-day-old male neonate for treatment of digoxin poisoning. The patient was being treated with digoxin for paroxysmal supraventricular tachycardia (PSVT). The prescription was written for digoxin elixir (50 micrograms/ml), 10 micrograms bid; however, it was dispensed as 100 micrograms bid. The patient had received seven of these doses over three and one half days prior to arrival at the emergency department. The patient received 40 mg of digoxin immune Fab fragments over one hour to bind a calculated maximum digoxin dose of 600 micrograms. The only complication was a transient episode of relative hypoglycemia 13 to 22 hours postinfusion with measured glucose readings between 43 and 52 mg/dl. The hypoglycemia responded to supplemental glucose and advancement of feedings. We believe that in massive and rapid electrolyte shifts in the neonate caused by digoxin immune Fab, glucose should be monitored closely.