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Crit Care Med. 2008 Nov;36(11):3014-8. doi: 10.1097/CCM.0b013e31818b341c.

Digoxin-specific Fab fragments as single first-line therapy in digitalis poisoning.

Author information

1
SAMU 93, EA 3409, Hôpital Avicenne, Bobigny, France. frederic.lapostolle@avc.ap-hop-paris.fr

Abstract

OBJECTIVE:

Despite administration of Fab fragments in digitalis poisoning, high mortality rates are consistently reported. A previous study suggested that Fab fragments prescribed as first-line therapy might improve mortality rate. Our objective was to evaluate this approach.

DESIGN:

Retrospective chart review (January 1990 to January 2004).

SETTING:

University hospital intensive care unit.

PATIENTS:

Consecutive patients admitted for cardiac glycoside poisoning.

INTERVENTION:

First-line therapy with Fab fragments (with or without atropine) in either curative or prophylactic doses.

MEASUREMENTS AND MAIN RESULTS:

A total of 141 patients were admitted for digitalis poisoning of whom 66 received first-line Fab fragment therapy. Their median age was 74 years (25th to 75th percentiles: 51-83); 76% were women. Half were intoxicated by digitoxin and half by digoxin. Median serum concentration was 168 (108-205) ng/mL for digitoxin and 6.2 (4.3-13.5) ng/mL for digoxin. Conduction disturbances were reported in 45 cases (68%) and ventricular arrhythmia in six cases (9%). Fab fragments were administered as curative treatment in 21 patients (32%) and prophylactically in 45 patients (68%). The median cumulative dose was 4 (4-6) vials. No adverse effects were reported. Five patients (7.6%) died.

CONCLUSIONS:

First-line therapy with Fab fragments in patients with digitalis poisoning was associated with a low mortality rate.

PMID:
18824911
DOI:
10.1097/CCM.0b013e31818b341c
[Indexed for MEDLINE]

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