Digoxin
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Arrhythmias, treated with anti-digoxin polyclonal antibody: case report A 53-year-old woman developed arrythmias secondary to digoxin; she was successfully treated with anti-digoxin polyclonal antibody and plasma exchange. The woman was admitted for atypical chest pain and exacerbation of chronic obstructive pulmonary disease. Subsequent ECG findings demonstrated nonspecific ST depression in the anterior leads. Telemetry revealed bradycardia, SVT, junctional rhythm and short runs of ventricular tachycardia. Serum digoxin concentration was 36 ng/mL [drug details not provided] and her potassium level was 6.4 mmol/L. The woman was transferred to the ICU, where she received magnesium and anti-digoxin polyclonal antibody. Her arrhythmias resolved and she remained haemodynamically stable until 32 hours later, when ventricular fibrillation heart arrest occurred. Advanced cardiac life support was administered until circulatory stability was restored. Left heart catheterisation showed a 30% mid-left anterior descending artery lesion, and she continued to experience arrhythmias. Thirty-seven hours after receiving anti-digoxin polyclonal antibody, her digoxin concentration was 20 ng/mL. Plasma exchange was performed, and her digoxin concentration was 10.4 ng/mL 1 hour later. Further anti-digoxin polyclonal antibody was administered and rifampicin was started. She was subsequently extubated and discharged home, with no neurological sequelae or arrhythmias. Nandwani V, et al. Severe digoxin cardiotoxicity treated with digoxin immune fab and plasma exchange. Critical Care Medicine 38 (Suppl.): 265 abstr. 946, No. 12, 801160345 Dec 2010. Available from: URL: http://www.sccm.org - USA
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Reactions 21 May 2011 No. 1352
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