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Severe digoxin intoxication in a child treated by infusion of digoxin-specific Fab-antibody-fragments
Insights
Accidental digoxin overdose in a child was treated with digoxin-specific antibody fragments. This rare emergency intervention successfully lowered toxic serum digoxin levels, preventing severe complications.
Area of Science:
- Pediatric Toxicology
- Cardiology
- Emergency Medicine
Background:
- Accidental digitalis (digoxin) ingestion in children is a rare but serious medical emergency.
- Digitalis toxicity can lead to life-threatening cardiac arrhythmias and conduction abnormalities.
Observation:
- A 2-year-old boy experienced accidental ingestion of 6 mg of beta-Acetyl-digoxin.
- The child developed progressive sinus bradycardia and SA/AV block without circulatory compromise.
Findings:
- Serum digoxin levels reached a toxic concentration of 21.7 ng/ml.
- Administration of digoxin-specific Fab-antibody fragments rapidly reduced free serum digoxin to undetectable levels.
- While arrhythmias persisted, necessitating pacemaker placement (though unused), the antibody infusion was well-tolerated.
Implications:
- Digoxin-specific antibody fragments are a crucial antidote for severe pediatric digitalis poisoning.
- Prompt recognition and intervention are vital for managing accidental digoxin overdose in children.
- This case highlights the efficacy and safety of antibody fragment therapy in pediatric toxicology.
Abstract:
Accidental digitalis ingestion in children is a rare, but potentially life-threatening emergency. We report the case of a 2 10/12-year-old boy with accidental ingestion of 6 mg beta-Acetyl-digoxin. Soon after admission, the boy developed sinus bradycardia, SA and AV-block, of increasing severity without circulatory impairment. As the serum digoxin level reached 21.7 ng/ml digoxin-specific Fab-antibody-fragments were used to bind free serum digoxin. Immediately after infusion, serum free digoxin was below the detection limit, whereas total digoxin peaked at 219 ng/ml 5 h thereafter. The arrhythmias did not subside totally, so that in addition, a transvenous pacemaker was placed, but never used. The antibody-infusion was well tolerated and the boy was discharged in good health.