Digoxin-specific antibody fragments for the treatment of suspected Nerium oleander toxicosis in a cat

Abstract

Case summary A 6-year-old castrated male domestic shorthair cat presented for lethargy and gastrointestinal signs after possible exposure to Nerium oleander leaves. The cat developed a ventricular arrhythmia that responded positively to the administration of digoxin-specific antibody fragments. Underlying hypertrophic cardiomyopathy was also diagnosed after the development of congestive heart failure. Humane euthanasia was elected owing to a lack of significant response to continued therapy. Relevance and novel information To our knowledge, this is the first report to describe the use of digoxin-specific antibody fragments in a cat. Nerium oleander toxicosis is associated with significant morbidity and mortality, and digoxin-specific antibody fragments have been used effectively in humans and animals. The development of cardiac necrosis may have contributed to worsening arrhythmias and highlights the importance of early intervention. The use of digoxin-specific antibody fragments for suspected N oleander toxicosis in a cat resulted in a rapid response and appeared to be well tolerated.

Preliminary investigation of the safe dose of oleandrin when administered orally to Beagles

“…These antidotes contain antigen-binding fragments and are used to treat life-threatening overdoses of digoxin or digitoxin, bofutoxin, and oleander. [27][28][29] Anti-digoxin Fab has been used with success in oleander poisoning in dogs 30,31 and at least 1 cat 28 (the latter received 38 mg of Digibind). Urine output should be monitored when digoxin immune Fab is used.…”

Oleandrin: A Systematic Review of its Natural Sources, Structural Properties, Detection Methods, Pharmacokinetics and Toxicology

“…Symptoms of poisoning due to excessive intake of oleandrin are very similar to those of digoxin intake, in that the first symptoms commonly include gastrointestinal discomfort, nausea, vomiting, and abdominal pain, with mild to severe diarrhea ( Chan and Buckley, 2014 ; Hudson et al, 2018 ; Botelho et al, 2020 ; Galton et al, 2020 ). These symptoms are followed by neurological symptoms, including drowsiness, insanity, generalized weakness, hyperkalemia, and potentially lethal cardiotoxicity, usually with arrhythmia, fibrillation by bradycardia and atrioventricular conduction block due to conduction issues ( Clark et al, 1991 ; Haeba et al, 2002 ; Yanyan.…”