ACUTE DIGOXIN OVERDOSE IN A NEWBORN WITH RENAL-FAILURE - USE OF DIGOXIN IMMUNE FAB AND PERITONEAL-DIALYSIS

Digitalis intoxication is a common problem, mainly because of the narr ow margin of safety of digoxin. These patients may have concomitant re nal failure. In patients who have renal failure and who have been trea ted with digoxin-Fab, the elimination of the digoxin-Fab complex is si gnificantly delayed, and there is a risk of dissociation of the comple x with rebound of free digoxin and recurrence of toxicity. The high mo lecular weight of digoxin and digoxin-Fab complex prevents its elimina tion by hemodialysis or continuous arteriovenous hemofiltration. A 3-d ay-old newborn with digoxin overdose and acute renal failure was treat ed with digoxin immune Fab and peritoneal dialysis. Low levels of tota l digoxin were measured in the dialyzate, indicating poor elimination of the digoxin-Fab complex through peritoneal dialysis.