Digitoxin poisoning: reversing ventricular fibrillation with Fab fragments of anti-digoxin antibody

Purified Fab fragments of ovine anti-digoxin antibodies (Wellcome Foundation) were used to treat a patient who attempted suicide by absorbing 10 mg of digitoxin (serum concentration 265 micrograms/l). The poor prognosis, as assessed clinically and from serum potassium levels (7.5 mEq/l), seemed to w...

Full description

Saved in:
Bibliographic Details
Published inLa Nouvelle presse medicale Vol. 11; no. 52; p. 3827
Main Authors Domart, Y, Bismuth, C, Schermann, J M, Abuaf, N, Pontal, P G, Baud, F, Bolo, A, Gailliot, M, Fournier, P E
Format Journal Article
LanguageFrench
Published France 25.12.1982
Subjects
Aged
Animals
Antibodies - administration & dosage
Cross Reactions
Digitoxin - blood
Digitoxin - toxicity
Digitoxin - urine
Digoxin - immunology
Humans
Immunoglobulin Fab Fragments - urine
Inactivation, Metabolic
Male
Potassium - blood
Sheep
Suicide, Attempted
Ventricular Fibrillation - chemically induced
Ventricular Fibrillation - therapy
Online AccessGet more information

Cover

More Information
Summary:Purified Fab fragments of ovine anti-digoxin antibodies (Wellcome Foundation) were used to treat a patient who attempted suicide by absorbing 10 mg of digitoxin (serum concentration 265 micrograms/l). The poor prognosis, as assessed clinically and from serum potassium levels (7.5 mEq/l), seemed to warrant such a treatment. The weak (6.85%) cross-reactivity elicited in vitro between the anti-digoxin antibodies and digitoxin was compensated by increasing the doses, but improvement was observed with 3.6 g, i.e. about half the effective dosage initially considered. The criteria of effectiveness were clinical, electrocardiographic (reversal of the ventricular fibrillation), biochemical (simultaneous and opposite changes in extra- and intracellular potassium levels, suggesting that ATPase inhibition by digitalis is a reversible process) and toxicological: there was an increase in digitoxin serum levels suggesting displacement of the drug from tissue sites to plasma and other extracellular compartments where the Fab fragments are distributed, and Fab-bound digitoxin appeared fairly rapidly in the urine, which suggested shunting of the normal hepatic metabolic pathway.
ISSN:0301-1518