To Bind or Not to Bind?

An 88-year-old man with a history of congestive heart failure, hypertension, and diabetes mellitus presented to the ED from a nursing home with altered mental status. EMS reported that the patient has had a decreased appetite, diarrhea, and weakness for three days. His initial vital signs were temperature 97.9°F, heart rate 79 bpm, blood pressure 116/64 mm Hg, respiratory rate 16 bpm, and pulse oximetry 98% on room air. His physical exam was remarkable for a depressed level of consciousness. Lab findings showed a creatinine of 2.6 mg/dl, a BUN of 60 mg/dl, and normal potassium and magnesium. His ECG is shown below.     The nursing home transfer sheet said the patient had reported yellow-tinted vision several days earlier. The patient’s medications include Lasix, digoxin, lisinopril, and insulin. Digoxin was last administered as prescribed six hours previously. A digoxin level was ordered and came back at 5.1 ng/ml.   Given the patient’s medication history, serum digoxin level, and altered mental status, digoxin-specific antibody fragments were administered for digoxin toxicity. The medical toxicologist and the emergency physician discussed the appropriate dose for this patient for full vs. partial reversal. Based on the serum digoxin concentration and his weight (80 kg), the calculated dosage for full reversal was four vials and for partial reversal was two vials of digoxin-specific antibody fragments. The dosage for full reversal was administered. One hour later, t...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs