Digoxin immune fab: Difference between revisions
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***Number of vials = TBL X 2 (round up to nearest whole number) | ***Number of vials = TBL X 2 (round up to nearest whole number) | ||
*'''Steady state digoxin level is known''' | *'''Steady state digoxin level is known''' | ||
**Number of vials = (dig level (in ng/mL) X | **Number of vials = (dig level (in ng/mL) X patient wt) / 100 | ||
*'''Chronic toxicity without severe signs''' | *'''Chronic toxicity without severe signs''' | ||
**Give half the recommended dose | **Give half the recommended dose | ||
***Otherwise may unmask the condition for which the | ***Otherwise may unmask the condition for which the patient is taking digoxin | ||
*'''Cardiac Arrest''' | *'''Cardiac Arrest''' | ||
**20 vials administered undiluted by IV bolus | **20 vials administered undiluted by IV bolus | ||
Revision as of 02:45, 2 July 2016
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)
- Calculate total body load (TBL)
- Steady state digoxin level is known
- Number of vials = (dig level (in ng/mL) X patient wt) / 100
- Chronic toxicity without severe signs
- Give half the recommended dose
- Otherwise may unmask the condition for which the patient is taking digoxin
- Give half the recommended dose
- Cardiac Arrest
- 20 vials administered undiluted by IV bolus