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Acute digoxin overdose: use of digoxin-specific antibody fragments
1Emergency Medicine Residency, Thomas Jefferson University, Philadelphia, PA.
Abstract:
An acute ingestion of 6 to 7 mg digoxin as a suicidal gesture in a 76-year-old man with chronic heart disease is presented. The patient arrived in the emergency department approximately 5 hours after ingestion with a normal serum potassium and increasing numbers of multifocal premature ventricular contractions. Digoxin-specific antibody fragments were administered. The patient developed ventricular tachycardia and ventricular fibrillation and was eventually stabilized 35 minutes after the Fab fragments were infused. A review of the pharmacology and indications for use of digoxin-immune Fab fragments is also presented.
Insights
A 76-year-old man survived a massive digoxin overdose thanks to digoxin-specific antibody fragments. This case highlights the effectiveness of Fab fragments in treating severe digoxin toxicity, even in complex cardiac patients.
Area of Science:
- Cardiology
- Clinical Toxicology
- Pharmacology
Background:
- Digoxin is a cardiac glycoside used to treat heart failure and arrhythmias.
- Acute digoxin toxicity can lead to life-threatening cardiac arrhythmias.
- Elderly patients with chronic heart disease are particularly vulnerable to digoxin toxicity.
Observation:
- A 76-year-old male with chronic heart disease ingested 6-7 mg of digoxin suicidally.
- The patient presented with multifocal premature ventricular contractions 5 hours post-ingestion.
- Serum potassium was normal on presentation.
Findings:
- Digoxin-specific antibody fragments (Fab) were administered due to the severe presentation.
- The patient experienced ventricular tachycardia and ventricular fibrillation post-administration.
- Cardiac rhythm stabilized 35 minutes after Fab fragment infusion.
Implications:
- Digoxin-immune Fab fragments are a critical intervention for severe digoxin poisoning.
- Prompt administration of Fab fragments can be life-saving in digoxin toxicity.
- This case underscores the importance of recognizing and rapidly treating digoxin overdose in vulnerable populations.