Published 3 September 2009, doi:10.1136/bmj.b2884
Cite this as: BMJ 2009;339:b2884

Practice

Lesson of the Week

Digoxin specific antibody fragments (Digibind) in digoxin toxicity

Dorothy Ip, specialist registrar in acute medicine, Hafiz Syed, specialist registrar in geriatric medicine, Maurice Cohen, consultant physician in geriatric medicine

1 North Middlesex Hospital, London N18 1QX

Correspondence to: D Ip dorothyip@doctors.org.uk

Digoxin levels may be falsely raised after administration of digoxin specific antibody fragments

The first 150 words of the full text of this article appear below.

Digoxin levels are requested in patients who present with symptoms of digoxin toxicity. Digoxin specific antibody fragments are indicated but can falsely raise digoxin level. The administration of a further dose of should be guided by the patient’s symptoms rather than the digoxin level.

A 78 year old woman was admitted with acute renal impairment and syncope after a lower respiratory tract infection and poor hydration. Her complex medical history included chronic atrial fibrillation, hypertension, congestive cardiac failure, and curative right hemicolectomy for caecal carcinoma. Regular medications included amlodipine, lisinopril, furosemide, spironolactone, digoxin, warfarin, lansoprazole, and quinine sulphate.

On admission, she was hypotensive and bradycardic. Apart from a painful left ankle, other systems were normal on examination. Initial blood tests showed a normocytic anaemia, hyponatraemia, hyperkalaemia, acute on chronic renal failure, raised inflammatory markers, international normalised ratio of 5.3, and digoxin concentration of 4.8 nmol/l. Her chest x ray film . . . [Full text of this article]


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Rapid Responses:

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'Treatment of hyperkalemia & digoxin toxicity'
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bmj.com, 12 Nov 2009 [Full text]
Authors' comments
Dorothy Ip, et al.
bmj.com, 17 Nov 2009 [Full text]
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