Successful Conventional Treatment of Digoxin Toxicity Without the Administration of Digoxin-Specific Antibody Fragment: A Case Report

Introduction: Digoxin (Digitalis) is widely used for the treatment of various cardiac conditions. However, due to its narrow therapeutic window, toxicity can occur, necessitating hospital admission and, in severe cases, the administration of digoxin-specific antibody fragments (DSFab). Digoxin-specific antibody fragments are not readily available in the pharmaceutical market in Iran, and most patients are treated conventionally instead. Here, we present a case of severe digoxin toxicity due to an acute overdose in a suicide attempt, successfully managed without the administration of DSFab. Case Presentation: A 45-year-old Iranian female patient presenting with symptoms of altered mental status, progressing to deep coma, was admitted to Ayatollah Taleghani Hospital in Urmia, Iran. She had ingested multiple drugs, including 50 tablets of 0.25 mg digoxin, in a suicide attempt. She was diagnosed with digoxin toxicity, and treatment was initiated immediately. Laboratory data revealed a potassium level of 5.5 mEq/L and a serum digoxin concentration of 5.6 ng/mL. Electrocardiograms showed ST depression in various leads, secondary to the digoxin effect. However, no signs of bradycardia or specific arrhythmias were observed. The patient was admitted to the intensive care unit (ICU), where treatment included mechanical ventilation, fluid replacement therapy, administration of laxatives, and gastric lavage. Cardiac monitoring was maintained, with correction of arrhythmias, electrolyte imbalances (most notably potassium levels), and acid-base disturbances. Serum concentrations of digoxin, potassium, and other electrolytes, along with venous blood gas status, were closely monitored. Concurrent conditions, including infections, liver function support, and anticoagulant therapy, were also managed appropriately. Conclusions: Despite not receiving DSFab, the patient responded well to a carefully managed conventional treatment plan, along with continuous paraclinical evaluations and cardiac monitoring. Her condition gradually improved, leading to a successful recovery. Given the limited availability of DSFab, alternative treatment protocols demonstrate promising outcomes in the management of digoxin toxicity. Additionally, clinical symptoms, cardiac status, and electrolyte balance appear to be more crucial factors in determining the need for DSFab than the ingested dosage or serum digoxin concentration. These findings suggest that a patient-centered approach focusing on clinical stability may be more effective in guiding DSFab administration decisions.