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Treatment of Life-Threatening Digitalis Intoxication with Digoxin-Specific Fab Antibody Fragments: Experience in 26 Cases
Abstract
Purified Fab fragments of digoxin-specific antibodies obtained from sheep were used to treat 26 patients with advanced, life-threatening digoxin (23 cases) or digitoxin (3 cases) toxicity. These patients had advanced cardiac arrhythmias, and in some cases hyperkalemia, which were resistant to conventional treatment. All patients had an initial favorable response to doses of Fab fragments calculated (in most cases) to be equivalent, on a molar basis, to the amount of cardiac glycoside in the patient's body. In four patients treated after prolonged hypotension and low cardiac output, death ensued from cerebral or myocardial hypoperfusion. In one case the available Fab fragment supply was inadequate to reverse a massive suicidal ingestion of digoxin, and the patient died after recurrent ventricular arrhythmias. In the remaining 21 patients, cardiac rhythm disturbances and hyperkalemia were rapidly reversed, and full recovery ensued. There were no adverse reactions to the treatment. We conclude that the use of purified digoxin-specific Fab fragments is a safe and effective means to reverse advanced, life-threatening digitalis intoxication.
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Cited by
Panchal, A. R., Bartos, J. A., Cabañas, J. G., Donnino, M. W., Drennan, I. R., Hirsch, K. G., Kudenchuk, P. J., Kurz, M. C., Lavonas, E. J., Morley, P. T., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000916 · Cited by 2,105
Topjian, A. A., Raymond, T. T., Atkins, D., Chan, M., Duff, J. P., Joyner, B. L., Lasa, J. J., Lavonas, E. J., Levy, A., Mahgoub, M., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000901 · Cited by 1,258
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.10.044 · Cited by 1,008
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000628 · Cited by 603
Digitalis: Mechanisms of Action and Clinical Use
Epstein, F. H., & Smith, T. W. (1988) · New England Journal of Medicine · doi:10.1056/nejm198802113180606 · Cited by 346
Self-citation
Metadata
- Authors
- Smith, T. W., Butler, V. P., Haber, E., Fozzard, H., Marcus, F. I., Bremner, W. F., Schulman, I. C., & Phillips, A.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1982-11-25
- Volume
- 307
- Issue
- 22
- Pages
- 1357-1362
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2056620103
- Cited by
- 296
- References
- 0
- FWCI
- 52.62
- Type
- journal article
- Language
- en
- Open access
- closed
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- CoChat. (2026). Citation check: Treatment of Life-Threatening Digitalis Intoxication with Digoxin-Specific Fab Antibody Fragments: Experience in 26 Cases. https://app.cochat.ai/papers/10.1056/nejm198211253072201
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- Smith, T. W., Butler, V. P., Haber, E., Fozzard, H., Marcus, F. I., Bremner, W. F., Schulman, I. C., & Phillips, A. (1982). Treatment of Life-Threatening Digitalis Intoxication with Digoxin-Specific Fab Antibody Fragments: Experience in 26 Cases. New England Journal of Medicine. https://doi.org/10.1056/nejm198211253072201
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