Smith T W, Haber E, Yeatman L, Butler V P
N Engl J Med. 1976 Apr 8;294(15):797-800. doi: 10.1056/NEJM197604082941501.
Purified Fab fragments of ovine digoxin-specific antibodies reversed severe digoxin intoxication in a patient who had taken 22.5 mg of the drug with suicidal intent. Atrioventricular block with extreme bradycardia was temporarily managed by pacing, but progressive, intractable hyperkalemia (serum potassium of 8.7 meq per liter) with increasing pacing threshold and progressive intraventricular conduction delay was controlled only after infusion of 1100 mg of Fab. Sinus rhythm returned 10 minutes after completion of Fab infusion. Within five hours, the serum potassium concentration fell to 4.0 meq per liter. Free digoxin concentrations in serum fell sharply to undetectable levels, whereas total serum digoxin concentration concomitantly increased 12-fold. Renal excretion of digoxin bound to Fab was documented. Reversal of toxicity was not accompanied by hemodynamic instability, and antibodies to sheep Fab fragments were not detected in the patient's serum after treatment. Thus, purified digoxin-specific Fab fragments are capable of rapid reversal of advanced digoxin toxicity.
纯化的羊地高辛特异性抗体Fab片段使一名蓄意服用22.5毫克该药物的患者严重的地高辛中毒得到逆转。伴有极度心动过缓的房室传导阻滞通过起搏暂时得到处理，但仅在输注1100毫克Fab后，逐渐加重的顽固性高钾血症（血清钾8.7毫当量/升）、起搏阈值增加以及进行性室内传导延迟才得到控制。Fab输注完成10分钟后窦性心律恢复。五小时内，血清钾浓度降至4.0毫当量/升。血清中游离地高辛浓度急剧下降至无法检测的水平，而血清总地高辛浓度相应增加了12倍。记录了与Fab结合的地高辛经肾脏排泄的情况。毒性逆转过程中未出现血流动力学不稳定，治疗后患者血清中未检测到针对羊Fab片段的抗体。因此，纯化的地高辛特异性Fab片段能够迅速逆转严重的地高辛中毒。
