[Immunopharmacologic treatment of 9 digitalis poisonings in children with sheep antidigoxin Fab]

A report is presented of the clinical experience in the treatment of severe digitalis poisoning in nine young children aged 1 month to 4 years with digitalis antibody fragments (Fab). In 8 cases, accidental poisoning was involved, and in one case there was overdosage during the course of treatment. Digoxin preparations had been taken by 8 of the cases, 6 times in liquid form, and in one case digitoxin. Reliable signs for the ingestion of digitalis with high concentrations in the serum and the appearance of life-threatening disorders of rhythm or conduction were taken as the indication for the use of Fab. The Fab dose was 80 to 480 mg per case treated and was adjusted according to the quantity of glycoside ingested. All of the children recovered completely. Regression of the arrhythmias and improvement of the clinical condition were seen during or shortly after administration of the Fab infusion. In the serum there was a rapid fall in the level of free digoxin and a simultaneous marked rise in that of bound inactive digoxin. The digoxin was excreted in the urine in the bound form. Tolerance was good. No allergic reactions to foreign protein or later reactions in the form of serum sickness were observed.