Digoxin immune fab

Fab Fragment Therapy (Digibind)

1. Indications
   1. Severe rhythm disturbances refractory to conventional therapy
   2. End-organ dysfunction
   3. Hyperkalemia >5 after acute overdose
   4. Pacemaker (may mask cardiac dysrhythmia)
   5. Consider for:
      1. Dig level > 10 in acute ingestion
      2. Dig level > 4 in chronic ingestion
      3. If adult acutely ingests > 10mg
      4. If child acutely ingests > 4mg
2. Side effects
   1. Allergic reaction
   2. Withdrawal of dig effect:
      1. CHF, a fib w/ RVR
   3. Hypokalemia
3. Initial response time ~ 20min, peak effect ~ 90min

How To Use

1. Neither amount ingested nor digoxin level are known:
   1. Adult dose
      1. 10 vials over 30 min
   2. Peds dose
      1. 5 vials over 30 min
      2. Repeat dose if clinical response is inadequate
2. Amount ingested is known but digoxin level is unknown
3. Calculate total body load (TBL)
   1. TBL = dose (in mg) ingested
4. Calculate number of vials needed
   1. Number of vials = TBL X 2 (round up to nearest whole number)
5. Steady state digoxin level is known
6. Number of vials = (dig level(in ng/mL) X pt wt) / 100
7. Chronic toxicity without severe signs
8. Give half the recommended dose
   1. Otherwise may unmask the condition for which the pt is taking digoxin
9. Cardiac Arrest
   1. 20 vials administered undiluted by IV bolus