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Reversing Digoxin Overdosage with Fab Antibody Fragments

Purpose: To calculate the amount of anti-digoxin Fab fragments to give in a patient with digoxin toxicity.

Description

Each 40 mg vial of digoxin-specific Fab fragments neutralizes about 0.6 mg of digoxin. The vial is reconstituted with 4 mL of sterile water. After mixing, the contents of the vials can be diluted in 0.9% sodium chloride to allow for more convenient infusion. The solution should be infused in 15-30 minutes. A 0.22 micron filter should be used to exclude undissolved immunoglobulin aggregates.


 

For acute digoxin ingestion

 

number of vials of Fab to give =

= (ingested dose of digoxin in mg) * 0.8 / 0.6

 

where:

• 0.6 represents the mg of digoxin neutralized by 1 vial

 

For chronic digoxin ingestion

 

number of vials of Fab to give =

= (serum digoxin level in ng/mL) * (body weight in kg) / 100

 

If symptoms are not adequately reversed, then the dosage can be repeated. After administration, total serum digoxin levels may be misleading and only free (not bound to protein) digoxin levels should be measured.

 

Note: The cost of anti-digoxin antibody is very high.

 


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Specialty

Objective

ICD-10