Digi-bind

 Q: Digoxin-specific antibody (Fab) fragments can be given as an IV push in a 'code' situation?

A) Yes

B) No

Answer: A

Ideally, Fab fragments should be given as an intravenous (IV) piggy bag over a half-hour period, but during cardiac arrest (code) or impending cardiac arrest, it can be given as a slow IV push. 

Another objective of this question is to emphasize the need for caution in giving Fab fragments to patients who are chronically on digoxin. In such patients, digoxin induced arrhythmia - such as AV nodal block - without hemodynamic compromise (means only EKG changes), should be treated with half of the calculated dose. Full dose Fab fragments in these patients may unmask the heart failure and may put the patient in cardiogenic shock or atrial fibrillation with the rapid ventricular response (A.fib. with RVR).

#cardiology

#pharmacology

References:

1. Bateman DN. Digoxin-specific antibody fragments: how much and when? Toxicol Rev. 2004;23(3):135-43. doi: 10.2165/00139709-200423030-00001. PMID: 15862081.

2. Chan BS, Buckley NA. Digoxin-specific antibody fragments in the treatment of digoxin toxicity. Clin Toxicol (Phila). 2014 Sep-Oct;52(8):824-36. doi: 10.3109/15563650.2014.943907. Epub 2014 Aug 4. PMID: 25089630.