Use of digoxin Fab immune fragments in a seven-day-old infant.

We report the use of digoxin immune Fab in a seven-day-old male neonate for treatment of digoxin poisoning. The patient was being treated with digoxin for paroxysmal supraventricular tachycardia (PSVT). The prescription was written for digoxin elixir (50 micrograms/ml), 10 micrograms bid; however, it was dispensed as 100 micrograms bid. The patient had received seven of these doses over three and one half days prior to arrival at the emergency department. The patient received 40 mg of digoxin immune Fab fragments over one hour to bind a calculated maximum digoxin dose of 600 micrograms. The only complication was a transient episode of relative hypoglycemia 13 to 22 hours postinfusion with measured glucose readings between 43 and 52 mg/dl. The hypoglycemia responded to supplemental glucose and advancement of feedings. We believe that in massive and rapid electrolyte shifts in the neonate caused by digoxin immune Fab, glucose should be monitored closely.