Background. - Despite the great progress which has been made in the treatme
nt of acute digitalis intoxication by digoxin-immune Fab, it still remains
a severe complication of cardiotonic therapy
Case report, - A neonate with ventricular septal defect and large left-to-r
ight shunt was treated with digitalis and diuretics at the usual starting d
oses. An intensive phototherapy was also required because of a hyperbilirub
inemia due to glucose-6-phosphate dehydrogenase deficiency Toxic digoxin ac
cumulation (plasma level 14 ng/mL) was diagnosed three days after the initi
ation of treatment by the presence of sinus bradycardia and bursts of Ventr
icular fibrillation. Intravenous administration of digoxin-specific antibod
y Fab fragments (Digidot(R)) was effective, with a rapid improvement of the
digitalis poisoning.
Conclusion, - Because of the particularities concerning drug distribution,
metabolism and elimination of drugs in the neonatal period, the digoxin the
rapeutic index is narrow. This case report suggests the involvement of phot
otherapy and diuretics, which might induce a significant decrease in extrac
ellular water and drug distribution volumes, ultimately promoting the occur
rence of an intoxication. (C) 2000 Editions scientifiques et medicales Else
vier SAS.