Fab fragments in the treatment of digoxin overdose: pediatric considerations

Serious digoxin toxicity due to accidental or deliberate overdose is uncommon, but more than half of the cases reported in 1985 involved children. Toxicity can occur acutely, as with accidental overdose, or with long-term maintenance dosing. In children it is almost always acute. Conventional treatment includes gastric lavage or ipecac-induced emesis, and activated charcoal or nonabsorbable resins and cathartics to reduce absorption. Although children appear to tolerate massive ingestions without specific therapy, serum digoxin levels must be reduced quickly and safely when conventional measures have failed. Fab fragments of digoxin-specific antibodies have been successfully used to treat refractory digoxin toxicity. Indications for use should be limited to life-threatening digoxin toxicity when conventional therapy has failed.