Severe digoxin intoxication in a child treated by infusion of digoxin-specific Fab-antibody-fragments

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Abstract
Accidental digitalis ingestion in children is a rare, but potentially life-threatening emergency. We report the case of a 210/12-year-old boy with accidental ingestion of 6 mg β-Acetyl-digoxin. Soon after admission, the boy developed sinus bradycardia, SA and AV-block, of increasing severity without circulatory impairment. As the serum digoxin level reached 21.7 ng/ml digoxin-specific Fab-antibody-fragments were used to bind free serum digoxin. Immediately after infusion, serum free digoxin was below the detection limit, whereas total digoxin peaked at 219 ng/ml 5 h thereafter. The arrhytmias did not subside totally, so that in addition, a transvenous pacemaker was placed, but never used. The antibody-infusion was well tolerated and the boy was discharged in good health.