Circulation, Vol 81, 1744-1752, Copyright © 1990 by American Heart Association
EM Antman, TL Wenger, VP Butler Jr, E Haber and TW Smith
One hundred fifty patients with potentially life-threatening digitalis
toxicity were treated with digoxin-specific antibody fragments (Fab)
purified from immunoglobulin G produced in sheep. The dose of Fab fragments
was equal to the amount of digoxin or digitoxin in the patient's body as
estimated from medical histories or determinations of serum digoxin or
digitoxin concentrations. The youngest patient received Fab fragments
within several hours of birth, and the oldest patient was 94 years old.
Seventy-five patients (50%) were receiving long-term digitalis therapy, 15
(10%) had taken a large overdose of digitalis accidentally, and 59 (39%)
had ingested an overdose of digitalis with suicidal intent. The clinical
response to Fab was unspecified in two cases, leaving 148 patients who
could be evaluated. One hundred nineteen patients (80%) had resolution of
all signs and symptoms of digitalis toxicity, 14 (10%) improved, and 15
(10%) showed no response. After termination of the Fab infusion, the median
time to initial response was 19 minutes, and 75% of the patients had some
evidence of a response by 60 minutes. There were only 14 patients with
adverse events considered to possibly or probably have been caused by Fab;
the most common events were rapid development of hypokalemia and
exacerbation of congestive heart failure. No allergic reactions were
identified in response to Fab treatment. Of patients who experienced
cardiac arrest as a manifestation of digitalis toxicity, 54% survived
hospitalization.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Treatment of 150 cases of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments. Final report of a multicenter study
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
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