Domart Y, Bismuth C, Schermann J M, Abuaf N, Pontal P G, Baud F, Bolo A, Gailliot M, Fournier P E
Nouv Presse Med. 1982 Dec 25;11(52):3827-30.
Purified Fab fragments of ovine anti-digoxin antibodies (Wellcome Foundation) were used to treat a patient who attempted suicide by absorbing 10 mg of digitoxin (serum concentration 265 micrograms/l). The poor prognosis, as assessed clinically and from serum potassium levels (7.5 mEq/l), seemed to warrant such a treatment. The weak (6.85%) cross-reactivity elicited in vitro between the anti-digoxin antibodies and digitoxin was compensated by increasing the doses, but improvement was observed with 3.6 g, i.e. about half the effective dosage initially considered. The criteria of effectiveness were clinical, electrocardiographic (reversal of the ventricular fibrillation), biochemical (simultaneous and opposite changes in extra- and intracellular potassium levels, suggesting that ATPase inhibition by digitalis is a reversible process) and toxicological: there was an increase in digitoxin serum levels suggesting displacement of the drug from tissue sites to plasma and other extracellular compartments where the Fab fragments are distributed, and Fab-bound digitoxin appeared fairly rapidly in the urine, which suggested shunting of the normal hepatic metabolic pathway.
用纯化的羊抗地高辛抗体Fab片段（威康基金会）治疗一名因摄入10毫克洋地黄毒苷（血清浓度265微克/升）而企图自杀的患者。从临床和血清钾水平（7.5毫当量/升）评估，预后较差，似乎有必要进行这种治疗。抗地高辛抗体与洋地黄毒苷在体外产生的较弱交叉反应性（6.85%）通过增加剂量得到补偿，但使用3.6克时观察到病情改善，即约为最初考虑的有效剂量的一半。有效性标准包括临床、心电图（室颤逆转）、生化（细胞内外钾水平同时出现相反变化，提示洋地黄对ATP酶的抑制是一个可逆过程）和毒理学方面：洋地黄毒苷血清水平升高，提示药物从组织部位转移到Fab片段分布的血浆和其他细胞外间隙，且与Fab结合的洋地黄毒苷相当迅速地出现在尿液中，这提示正常肝脏代谢途径发生了分流。
