Severe suicidal digoxin toxicity managed with resin hemoperfusion: A case report

Abstract

Owing to its wide and easy availability, digoxin has got a significant abuse potential and may be used for suicidal purposes. Digoxin-specific antibody (Fab) fragments have become the mainstay of therapy for severe digoxin toxicity and have significantly helped in reducing mortality. However, due to its high cost and limited availability alternative measures may need to be used to manage severe intoxications especially in countries like India, where Fab fragments are unavailable. Here, we present a case of a young female who presented to our casualty with alleged history of consumption of 17.5 mg of digoxin tablets. After admission to ICU, she developed atrioventricular blocks with hemodynamic instability which had to be managed with temporary pacemaker. Her serum digoxin levels were high (12.63 ng/ml) and in the absence of Fab fragments, resin hemoperfusion was done which drastically reduced the serum digoxin levels and reverted the symptoms.

Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe coronavirus disease 2019 (COVID-19)

“…We used HA-280 and HA-230 cartridges because we did not have access to other types like cytosorb, Jafron HA-380, and HA-330 in our country. There is a limited scienti c evidence about the application of HA-280 and HA-230 cartridges in clinical settings (24,25). Previous study in which the e cacy of HA-330 resin-directed hemoperfusion has been assessed in acute respiratory distress syndrome, some considerable treatment outcomes including improved oxygenation, reduction in lung edema and histopathological signs of acute respiratory distress syndrome, and reduced circulating and alveolar cytokine levels have been resulted; and the authors concluded that this cartridge could bene cially in uence the course of acute respiratory distress syndrome by attenuating systemic and pulmonary in ammatory cytokines (12).…”

Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe coronavirus disease 2019 (COVID-19)

“…We used HA-280 and HA-230 cartridges because we did not have access to other types like cytosorb, Jafron HA-380, and HA-330 in our country. There is a limited scientific evidence about the application of HA-280 and HA-230 cartridges in clinical settings [ 26 , 27 ]. Previous study in which the efficacy of HA-330 resin-directed hemoperfusion has been assessed in acute respiratory distress syndrome, some considerable treatment outcomes including improved oxygenation, reduction in lung edema and histopathological signs of acute respiratory distress syndrome, and reduced circulating and alveolar cytokine levels have been resulted; and the authors concluded that this cartridge could beneficially influence the course of acute respiratory distress syndrome by attenuating systemic and pulmonary inflammatory cytokines [ 12 ].…”

Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe coronavirus disease 2019 (COVID-19)

“…We used HA-280 and HA-230 cartridges because we did not have access to other types like cytosorb, Jafron HA-380, and HA-330 in our country. There is a limited scienti c evidence about the application of HA-280 and HA-230 cartridges in clinical settings (26,27). Previous study in which the e cacy of HA-330 resin-directed hemoperfusion has been assessed in acute respiratory distress syndrome, some considerable treatment outcomes including improved oxygenation, reduction in lung edema and histopathological signs of acute respiratory distress syndrome, and reduced circulating and alveolar cytokine levels have been resulted; and the authors concluded that this cartridge could bene cially in uence the course of acute respiratory distress syndrome by attenuating systemic and pulmonary in ammatory cytokines (12).…”