Digoxin immune fab
Background
- Also known as Digibind or Ovine
Indications
- Severe rhythm disturbances refractory to conventional therapy
- End-organ dysfunction
- Hyperkalemia >5 after acute overdose
- Pacemaker (may mask cardiac dysrhythmia)
- Consider for:
- Dig level > 10 in acute ingestion
- Dig level > 4 in chronic ingestion
- If adult acutely ingests > 10mg
- If child acutely ingests > 4mg
Side Effects
- Allergic reaction
- Withdrawal of dig effect:
- CHF, a fib w/ RVR
- Hypokalemia
- Initial response time ~ 20min, peak effect ~ 90min
How To Use
- Neither amount ingested nor digoxin level are known:
- Adult dose
- 10 vials over 30 min
- 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
- 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