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Failure of CAVH to remove digoxin-Fab complex in piglets
E J Quaife1, W Banner, D D Vernon
1Department of Pediatrics, University of Utah/Primary Children's Medical Center, Salt Lake City.
Journal of Toxicology. Clinical Toxicology
|January 1, 1990
Summary
Continuous arteriovenous hemofiltration (CAVH) is ineffective at removing the digoxin-Fab antibody fragment complex. This study found negligible removal of the complex during CAVH in piglets, suggesting it is not a viable detoxification method for digoxin toxicity.
Area of Science:
- Nephrology
- Toxicology
- Pharmacology
Background:
- Digoxin toxicity can be complicated by renal failure, impairing digoxin-Fab complex excretion.
- Continuous arteriovenous hemofiltration (CAVH) is a renal replacement therapy capable of filtering molecules up to 50,000 daltons.
Purpose of the Study:
- To evaluate the efficacy of CAVH in removing the digoxin-Fab fragment complex.
- To determine if the molecular weight of the digoxin-Fab complex (45-50,000 daltons) allows for its filtration via CAVH.
Main Methods:
- Three piglets were administered digoxin (100 mcg/kg IM).
- Anesthesia was induced, and CAVH was initiated using a Diafilter 10 cartridge, achieving a mean ultrafiltration rate of 3.6 mL/min.
- Serum and ultrafiltrate digoxin levels (total and free) were measured before and at 30, 60, and 90 minutes after Digibind administration.
Main Results:
- Post-Digibind administration, mean serum total digoxin levels ranged from 54.23 to 67.63 ng/ml, and free digoxin levels were consistently low (≤0.10 ng/ml).
- Ultrafiltrate digoxin levels remained negligible throughout the experiment (≤0.04 ng/ml).
Conclusions:
- Continuous arteriovenous hemofiltration is ineffective in removing the digoxin-Fab fragment complex.
- CAVH is not a suitable method for enhancing the clearance of digoxin-Fab complexes in cases of digoxin toxicity, particularly when renal function is compromised.