Digoxin immune fab: Difference between revisions
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==Background== | ==Background== | ||
* | *1 Fab vial binds 0.5mg of digoxin | ||
*Clinical improvement usually seen within 1hr | |||
*May give as IV bolus in cardiac arrest; otherwise give over 30min | |||
==Indications== | ==Indications== | ||
# | #Ventricular dysrhythmias | ||
#Hemodynamically significant bradyarrhythmias unresponsive to standard therapy | |||
#Hyperkalemia >5 | #Hyperkalemia > 5.5 a/w toxic digoxin level or presumptive diagnosis of overdose | ||
#Pacemaker (may mask cardiac dysrhythmia) | #Also consider for: | ||
##Pacemaker (may mask cardiac dysrhythmia) | |||
##Dig level > 10 in acute ingestion | ##Dig level > 10 in acute ingestion | ||
##Dig level > 4 in chronic ingestion | ##Dig level > 4 in chronic ingestion | ||
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==Side Effects== | ==Side Effects== | ||
#Withdrawal of dig effect: | #Withdrawal of dig effect: | ||
##CHF, | ##CHF, A-fib w/ RVR | ||
#Hypokalemia | #Hypokalemia | ||
==How To Use== | ==How To Use== | ||
#'''Neither amount ingested nor digoxin level are known:''' | #'''Neither amount ingested nor digoxin level are known:''' | ||
##Adult dose | ##Adult dose | ||
###10 vials over 30 min | ###10 vials over 30 min; repeat dose if clinical response is inadequate | ||
##Peds dose | ##Peds dose | ||
###5 vials over 30 min | ###5 vials over 30 min; repeat dose if clinical response is inadequate | ||
#'''Amount ingested is known but digoxin level is unknown''' | #'''Amount ingested is known but digoxin level is unknown''' | ||
#Calculate total body load (TBL) | #Calculate total body load (TBL) | ||
##TBL = | ##TBL = Dose (in mg) ingested x 0.8 | ||
#Calculate number of vials needed | #Calculate number of vials needed | ||
##Number of vials = TBL X 2 (round up to nearest whole number) | ##Number of vials = TBL X 2 (round up to nearest whole number) | ||
Revision as of 08:59, 28 January 2012
Background
- 1 Fab vial binds 0.5mg of digoxin
- Clinical improvement usually seen within 1hr
- May give as IV bolus in cardiac arrest; otherwise give over 30min
Indications
- Ventricular dysrhythmias
- Hemodynamically significant bradyarrhythmias unresponsive to standard therapy
- Hyperkalemia > 5.5 a/w toxic digoxin level or presumptive diagnosis of overdose
- Also consider for:
- Pacemaker (may mask cardiac dysrhythmia)
- Dig level > 10 in acute ingestion
- Dig level > 4 in chronic ingestion
- If adult acutely ingests > 10mg
- If child acutely ingests > 4mg
Side Effects
- Withdrawal of dig effect:
- CHF, A-fib w/ RVR
- Hypokalemia
How To Use
- Neither amount ingested nor digoxin level are known:
- Adult dose
- 10 vials over 30 min; repeat dose if clinical response is inadequate
- Peds dose
- 5 vials over 30 min; repeat dose if clinical response is inadequate
- Adult dose
- Amount ingested is known but digoxin level is unknown
- Calculate total body load (TBL)
- TBL = Dose (in mg) ingested x 0.8
- Calculate number of vials needed
- Number of vials = TBL X 2 (round up to nearest whole number)
- Steady state digoxin level is known
- Number of vials = (dig level(in ng/mL) X pt wt) / 100
- Chronic toxicity without severe signs
- Give half the recommended dose
- Otherwise may unmask the condition for which the pt is taking digoxin
- Cardiac Arrest
- 20 vials administered undiluted by IV bolus