• Am J Emerg Med · Apr 2019

    Case Reports

    Digoxin-specific Fab and therapeutic plasma exchange for digitalis intoxication and renal failure.

    • Marta Pellegrino and Mattia Garofalo.
    • Cardiovascular Department, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy. Electronic address: marta.pellegrino@humanitas.it.
    • Am J Emerg Med. 2019 Apr 1; 37 (4): 798.e3-798.e5.

    AbstractTreatment of chronic digitalis intoxication includes suspension of drug intake, which may be sufficient in case of mild manifestations, and supportive measures. Severe bradycardia requires the administration of atropine or isoproterenol; placement of a temporary pacemaker may be required in case of absent response to pharmacological therapy. Severe and life-threatening manifestations should be treated with digoxin-specific fragment antigen binding antibodies (Fab). Therapeutic plasma exchange has been suggested, in addition to Fab therapy, to maximize the clearance of Fab-digoxin complexes in patients with renal failure. To date, few case reports have described the use of such a therapeutic approach; currently, extracorporeal methods are not recommended as part of the treatment of digitalis intoxication, and stronger evidence is required to establish their benefit.Copyright © 2019. Published by Elsevier Inc.

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