Digoxin-Specific Fab Fragments As Single First-Line Therapy In Digitalis Poisoning

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. (Crit Care Med 2008; 36:3014-3018)