Severe digoxin intoxication: A case report of the use of digoxin-specific Fab antibody fragments

Abstract

Digoxin is a cardiac glycoside that has been used for several decades to treat heart failure and atrial fibrillation. Several doctors prescribe it to their patients, although it is not the first choice for either condition. In rare cases, intoxication can occur, leading to life-threatening cardiac arrhythmias. Here we report the case of an 84-year-old Caucasian woman who presented to the emergency department with dyspnoea, cough, and bilateral lower limb oedema. Eight days prior to her presentation, she had been prescribed methyldigoxin. As the patient had undiagnosed dementia and was taking medication without supervision, she ingested toxic amounts of the drug. Electrocardiogram showed the presence of arrhythmia, which resolved after using digoxin-specific Fab antibody fragments. In elderly patients, special care should be exercised when prescribing drugs with narrow therapeutic windows.