[Suicidal digitalis poisoning: considerations concerning treatment strategy with antibodies]

Suicidal digitalis poisoning is life-threatening and often has a fatal outcome. The treatment and clinical course of acute poisoning with 250 mg digitoxin in a depressive male patient aged 48 years are reported. Marked elevation of serum digitoxin level (360 nmol/l 8 hours after ingestion) and initial hyperkalemia (5.7 mmol/l) as well as the history of excessive dose intake, pointed toward severe intoxication. Mainstays of management with favourable outcome were vomiting and gastric lavage, followed by administration of repeated doses of digoxin-specific Fab antibody fragments. Evaluation of severity of poisoning and recommended supportive measures in digitalis overdose suicide victims are summarized and practical features of antibody preparations are discussed.