| Title | Digoxin-specific Fab fragments as single first-line therapy in digitalis poisoning. | | Author(s) | Lapostolle F, Borron SW, Verdier C, Taboulet P, Guerrier G, Adnet F, Clemessy JL, Bismuth C, Baud FJ | | Institution | SAMU 93, EA 3409, Hôpital Avicenne, Bobigny, France. frederic.lapostolle@avc.ap-hop-paris.fr | | Source | Crit Care Med 2008 Nov; 36(11):3014-8. | | 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. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 18824911 |
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