Digitalis intoxication in the neonatal period: role of dehydration.

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.