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Critical Care Toxicology pp 1–10Cite as

Anti-digoxin-Specific Fab Fragments

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Abstract

Digitalis poisoning is rare but may be responsible for life-threatening complications [1–3]. Intoxication may result from suicidal or unintentional ingestion of a single large dose (acute poisoning) or from accumulation during long-term dosing (chronic poisoning). Anti-digoxin-specific Fab fragments are now considered as the first-line treatment of digitalis poisoning [4–6]. However, several concerns remain including the indications, the minimal efficient dose, and the optimal mode of administration. Despite being an expensive therapy, anti-digoxin Fab fragments were considered beneficial in a cost-effectiveness analysis [7]. This antidote was shown useful not only in digoxin poisoning but also in poisonings with digitoxin, lanatoside C, and various cardiac glycosides contained in plants such as oleander, foxglove, and lily of the valley or venoms from toads and coconut crabs (Birgus latro L.) [8–12]. To date, different marketed safe and effective digitalis antitoxins are available including DigiFab (40 mg).

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Author information

Authors and Affiliations

  1. Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, INSERM U1144, Paris, France

    Bruno Mégarbane

Authors
  1. Bruno Mégarbane
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Correspondence to Bruno Mégarbane .

Editor information

Editors and Affiliations

  1. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Jeffrey Brent

  2. Office of New Drugs Drug Evaluation and Research, FDA, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas' Hospital, London, United Kingdom

    Paul Dargan

  4. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Benjamin Hatten

  5. Med & Toxicological Intensive Care Unit, Lariboisière Hospital Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Robert Palmer

  7. Toxinology Department, Women’s and Children’s Hospital, Toxinology Department, North Adelaide, South Australia, Australia

    Julian White

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies, and case reports, or reports of expert committees.

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Mégarbane, B. (2017). Anti-digoxin-Specific Fab Fragments. In: Brent, J., et al. Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-20790-2_160-2

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  • DOI: https://doi.org/10.1007/978-3-319-20790-2_160-2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-20790-2

  • Online ISBN: 978-3-319-20790-2

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Chapter history

  1. Latest

    Anti-digoxin-Specific Fab Fragments
    Published:
    24 June 2017

    DOI: https://doi.org/10.1007/978-3-319-20790-2_160-2

  2. Original

    Anti-digoxin-Specific Fab Fragments
    Published:
    05 November 2016

    DOI: https://doi.org/10.1007/978-3-319-20790-2_160-1

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