Free and Total Digoxin in Serum During Treatment of Acute Digoxin Poisoning With Fab Fragments: Case Study. American journal of critical care : an official publication, American Association of Critical-Care Nurses [Am J Crit Care] Journal article | | Title | Free and Total Digoxin in Serum During Treatment of Acute Digoxin Poisoning With Fab Fragments: Case Study. | | Author(s) | Eyer F, Steimer W, Müller C, Zilker T | | Institution | Florian Eyer is a clinical toxicologist, specialist in internal medicine and intensive care medicine, and Thomas Zilker is a clinical toxicologist, specialist in internal medicine and endocrinology, in the Department of Clinical Toxicology at Technische Universität, Munich, Germany. Werner Steimer is a specialist in clinical pathobiochemistry and drug monitoring and Christine Müller is the technical assistant in the former laboratory at Klinikum rechts der Isar, Technische Universität, Munich, Germany. | | Source | Am J Crit Care 2009 Oct 29. | | Abstract | A woman ingested 10 mg of methyldigoxin in a suicide attempt and presented 19 hours after ingestion with clinical signs of glycoside intoxication. Her serum level of digoxin was 7.4 ng/mL, and antidotal therapy with Fab antibody fragments was started. The manufacturer's recommended dosing scheme was modified, with 80 mg Fab administered intravenously within 15 minutes followed by a continuous infusion at 30 mg/h. Total serum concentration of digoxin increased markedly within minutes after Fab therapy was started, while the level of free digoxin immediately decreased into the nontoxic range without recrudescent toxic effects of digoxin. The cumulative amounts of free and bound digoxin that were excreted in urine within 30 hours after ingestion were 900 mug and 1600 mug, respectively. Half-life of bound digoxin in urine was 9.9 hours; mean rate of clearance of bound digoxin in the urine was 7.0 mL/min. On the basis of these kinetic data, a smaller initial bolus dose of Fab followed by a continuous infusion may be a more tailored, cost-effective, and relatively safe therapy for patients who have overdosed on cardiac glycosides. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19875723 |
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