DIGOXIN INTOXICATION IN A PATIENT WITH END-STAGE RENAL-DISEASE - EFFICACY OF DIGOXIN-SPECIFIC FAB ANTIBODY FRAGMENTS AND PERITONEAL-DIALYSIS

Digoxin intoxication is a serious medical problem, and impairment of r enal function is a common risk factor for toxicity. Digoxin specific a ntibody fragments (Fab) is the most effective treatment available for severe digitalis intoxication. The use of Fab therapy in a patient wit h renal disease is considered as effective as in patients with normal renal function, although the increased risk of rebound digoxin toxicit y mandates a longer period of observation. In patients with kidney fai lure, neither digoxin nor Fab can be removed efficiently from the syst emic circulation by hemodialysis or continuous arteriovenous hemofiltr ation. Knowledge about the clearance of both compounds by peritoneal d ialysis is limited. The authors describe a patient with end stage rena l disease who was treated with Fab and peritoneal dialysis for life th reatening digoxin intoxication. Like other forms of dialysis, peritone al dialysis, even when performed in an intensive schedule, is not asso ciated with an enhanced clearance of digoxin.