Combined use of plasmapheresis and antidigoxin antibodies in a patient with severe digoxin intoxication and acute renal failure

Abstract

Digitalis intoxication is a common and potentially life-threatening situation [ 1 ]. In this condition, the administration of digoxin-specific antibodies (Fab) have proven to be effective in controlling serious complications [ 2 ]. However, in patients with severe renal impairment, the clearance of Fab–digoxin complexes is compromised, and this may reduce the utility of Fab therapy in those conditions. Plasmapheresis (PE), by removing the digoxin–Fab complexes, was suggested to prevent the phenomenon of rebound toxicity, which is frequently observed in conditions of renal failure [ 3 ], and the combined use of Fab and PE in digitalis intoxication associated with severe renal failure has been reported [ 4 ]. However, because in those cases PE was initiated several hours after the administration of Fab, the best therapeutic strategy still remains to be established [ 5 ]. We report a case of combined use of Fab closely followed by a single session of PE in a patient with severe digitalis intoxication.