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Case Reports
. 2024 Mar 5;18(1):135.
doi: 10.1186/s13256-024-04386-6.

Successful management of massive digoxin overdose using DIGIFab and therapeutic plasma exchange: a case report

Reema M Alhussein  1 , Nawaf A Alamri  2 , Hussain M Alhashem  2 , Mohammed I Alarifi  3 , Bader Alyahya  4
Affiliations
Case Reports

Successful management of massive digoxin overdose using DIGIFab and therapeutic plasma exchange: a case report

Reema M Alhussein et al. J Med Case Rep. .

Abstract

Background: Despite the efficacy and safety of DIGIFab, it is relatively expensive and has limited availability. In addition, alternative interventions, such as therapeutic plasma exchange, may need to be considered in massive digoxin overdoses. Although few case reports describe its efficacy.

Case presentation: We report a case of a 17-year-old white male patient brought by family members to our emergency department in Riyadh, Saudi Arabia. After intentionally ingesting 48 mg of digoxin tablets to commit suicide, the patient's initial digoxin serum level was 8.04 ng/mL. The patient was resuscitated in the emergency department. After admission to the intensive care unit, the patient underwent therapeutic plasma exchange, because of insufficient DIGIFab doses. Afterward, the serum digoxin levels drastically decreased, and his symptoms reverted. The patient was successfully managed and discharged 7 days after admission.

Conclusion: Despite insufficient evidence and a limited number of case reports describing the use of extracorporeal treatment in digoxin overdose, we noted the significant impact of therapeutic plasma exchange on our patient. However, therapeutic plasma exchange's use in routine treatment requires stronger evidence to confirm its benefits.

Keywords: Case report; DIGIFab; Digoxin; Drug overdose; ECTR; Plasma exchange; TPE.

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Conflict of interest statement

The authors declare that there is no competing interest.

Figures

Fig. 1
Fig. 1
Initial electrocardiogram revealed a sinus tachycardia
Fig. 2
Fig. 2
Electrocardiogram revealed a sinus bradycardia, first-degree heart block with T-wave inversion in anterio-septal leads
Fig. 3
Fig. 3
Our patient’s serum digoxin and potassium concentrations during and since presentation. Arrow (1): Initial digoxin level upon arrival 4 hours post-ingestion. Arrow (2): Digoxin level after therapeutic plasma exchange and DIGIFab. Arrow (3): Serum digoxin on second day. Arrow (4): Upon discharge
See this image and copyright information in PMC

References

    1. Ciechański E, Ciechański KL, Tchórz M. Suicidal digoxin intoxication in 61 year old patient. J Educ Health Sport. 2019;9(8):801–806.
    1. Patocka J, Nepovimova E, Wu W, Kuca K. Digoxin: pharmacology and toxicology—a review. Environ Toxicol Pharmacol. 2020;1(79):103400. doi: 10.1016/j.etap.2020.103400. - DOI - PubMed
    1. Hauptman PJ, Blume SW, Lewis EF, Ward S. Digoxin toxicity and use of digoxin immune fab: insights from a national hospital database. JACC Heart Failure. 2016;4(5):357–364. doi: 10.1016/j.jchf.2016.01.011. - DOI - PubMed
    1. Szponar J, Tchórz M, Drelich G, Gnyp L, Lewandowska-Stanek H. Severe digoxin poisoning a case study. Przegl Lek. 2011;68(8):515–517. - PubMed
    1. See I, Shehab N, Kegler SR, Laskar SR, Budnitz DS. Emergency department visits and hospitalizations for digoxin toxicity: United States, 2005 to 2010. Circulation. 2014;7(1):28–34. - PMC - PubMed

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