MASSIVE DIGITOXIN INTOXICATION TREATED WITH DIGOXIN-SPECIFIC ANTIBODIES IN A CHILD

A 20-month-old girl with massive digitoxin intoxication (initial digit oxin serum level: 629 ng/ml) was successfully treated with digoxin-spe cific antibody fragments (Fab). She presented with moderate signs of d igitalis toxicity (somnolence, bradycardia, first-degree AV block) and improved rapidly during fractional Fab administration. Free serum-dig itoxin disappeared after 6 vials of Fab (480 mg), but was measurable a gain on days 6 and 7. This case demonstrated that digoxin-specific ant ibodies, despite a 30-100 times lesser affinity for digitoxin, are eff ective in massive digitoxin intoxications. A rebound phenomenon may oc cur several days later and should be taken into consideration.