4CPS-200 Case report: treatment of digoxin intoxication in a haemodialysis patient using anti-digoxin antibodies and plasmapheresis
Year: 2025
Type: conference-paper
Study design: Case Report
Abstract: Background and Importance Digoxin intoxication is a life-threatening condition in which digoxin-specific antibody fragments (Fab) have been shown to be effective1. In patients with renal failure and chronic haemodialysis (HD), the clearance of Fab-digoxin complexes is significantly reduced. Some cases report using plasmapheresis (PE) to remove complexes and prevent toxicity recurrence1–8. This case presents the combined use of Fab and PE in a severe digoxin intoxication Aim and Objectives Male, 84 years-old, weight 71kg, was admitted to the emergency department for asthenia. His medical record included permanent atrial fibrillation (AF), congestive heart failure, stage V chronic kidney disease on HD and diabetes mellitus. His regular medication includes apixaban, bisoprolol, 0.25mg digoxin, furosemide, sitagliptin, simvastatin, and trazodone. Material and Methods Physical examination revealed a blood pressure of 160/92 mmHg, an ECG showing AF with complete atrioventricular block with a heart rate (HR) of 40 bpm and narrow QRS. Positive Sars-Cov2 PCR. Digoxin levels (DL) 5.73 ng/ml. Consequently, he was hospitalised in the intensive care unit (ICU). We used the following formula9 to calculate the dose of Fab to administer and figure 1 shows a timeline with the interventions performed and clinical parameters: After the first administration, we observed a rebound effect increasing the DL. Therefore, we decided to perform a PE 3 hours after Fab administration, and the LD were significantly reduced. Results The acute process lasted eight days and required four administrations of Fab, the last three followed by a PE session. This combination reduced the LD by 43%, 60% and 47%, respectively. HR was re-established with the decrease DL, reaching stable values on day 9 allowing the patient being discharged from the ICU. Conclusion and Relevance The combination of PE after Fab administration is not described in clinical guidelines, only a few published cases1–8. There is also no consensus on when to perform PE, although it is estimated that the optimal time is 1–3h after Fab administration5. In this case, we observed a significant benefit of Fab administration followed by PE on clinical symptoms and DL. Further studies are needed to determine when PE should be used in clinical practice. References and/or Acknowledgements Conflict of Interest No conflict of interest
Authors: A Martín Santamaría, C Lozano Llano, S Renedo Martinez, A Matutano Muñoz, AC Sanchez Cerviño, M Rivera Ruiz, I Guerrero Feria, M Calvo Salvador, B Rodriguez Marrodan, L Delgado Tellez de Cepeda, A Sanchez Guerrero
Institution: Hospital Universitario Puerta de Hierro Majadahonda
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4408376504