Battegay M, Cottier C, Burckhardt D, Ritz R
Schweiz Rundsch Med Prax. 1989 Aug 15;78(33):880-2.
We report a case of severe digitoxin poisoning with--as to our knowledge--the highest plasma concentration reported so far (376 ng/ml). On admission, the patient suffered from nausea and vomiting. The ECG showed a complete AV-block which was managed temporarily by pacing. Phenytoin was given for ventricular tachycardias. The plasma potassium level was 7.4 mmol/l. The elimination of the digitoxin was enhanced with cholestyramine and hemoperfusion. Because of persisting arrhythmias, hyperkalemia and a very high digitoxin level, purified Fab fragments of digoxin-specific antibodies (cross-reacting with digitoxin) were administered. After a first dose of 480 mg nausea disappeared readily, and with a second dose of 480 mg cardiac rhythm disturbances and hyperkalemia were overcome. There were no adverse reactions to treatment. We confirm the effectiveness of digoxin-specific Fab antibody fragments in life-threatening digitoxin intoxication.
我们报告了一例严重的洋地黄毒苷中毒病例，据我们所知，其血浆浓度是迄今为止报告的最高值（376 ng/ml）。入院时，患者出现恶心和呕吐症状。心电图显示完全性房室传导阻滞，通过起搏进行了临时处理。给予苯妥英钠治疗室性心动过速。血浆钾水平为7.4 mmol/l。使用消胆胺和血液灌流促进了洋地黄毒苷的清除。由于心律失常、高钾血症持续存在且洋地黄毒苷水平极高，给予了地高辛特异性抗体（与洋地黄毒苷交叉反应）的纯化Fab片段。首剂480 mg后恶心迅速消失，再给予480 mg后，心律失常和高钾血症得到控制。治疗过程中未出现不良反应。我们证实了地高辛特异性Fab抗体片段在危及生命的洋地黄毒苷中毒中的有效性。
