| Anti-digoxin Fab fragments in cardiotoxicity induced by ingestion of yellow oleander: a randomised controlled trial. | |
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MedLine Citation:
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PMID: 10768435 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Severe cardiac glycoside cardiotoxicity after ingestion of yellow oleander seeds is an important problem in rural areas of Sri Lanka. Currently, patients must be transferred to the capital for temporary cardiac pacing. We did a randomised controlled trial to investigate whether anti-digoxin Fab could reverse serious oleander-induced arrhythmias. METHODS: After a preliminary dose-finding study, 66 patients who presented to hospital with a serious cardiac arrhythmia were randomised to receive either 1200 mg of anti-digoxin Fab or a saline placebo. A 12-lead electrocardiogram, 3 min rhythm strip, and blood sample for measurement of electrolytes and cardiac glycosides were taken before treatment and at 12 timepoints thereafter. FINDINGS: 34 patients received anti-digoxin Fab and 32 received placebo. The presenting arrhythmia had resolved completely after 2 h in 15 antibody-treated patients and two controls (p<0.001); 24 and five patients, respectively, were in sinus rhythm at 8 h (p<0.001). Kaplan-Meier analysis of time to first reversal showed a significant response to anti-digoxin Fab. The heart rate increased in cases, from 49.1 per min at baseline to 66.8 at 2 h, but not in controls (50.6 per min at baseline to 51.5; p<0.001). Mean serum potassium concentrations decreased from 4.9 mmol/L to 4.1 mmol/L at 2 h in cases; no such decrease occurred in controls. INTERPRETATION: Anti-digoxin Fab fragments are a safe and effective treatment for serious cardiac arrhythmias induced by yellow oleander. Their use in small rural hospitals in Sri Lanka should minimise costly transfer of patients and reduce the numbers of deaths; however, further study will be required to confirm this reduction. |
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Authors:
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M Eddleston; S Rajapakse; Rajakanthan; S Jayalath; L Sjöström; W Santharaj; P N Thenabadu; M H Sheriff; D A Warrell |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Lancet Volume: 355 ISSN: 0140-6736 ISO Abbreviation: Lancet Publication Date: 2000 Mar |
Date Detail:
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Created Date: 2000-05-01 Completed Date: 2000-05-01 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 2985213R Medline TA: Lancet Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 967-72 Citation Subset: AIM; IM |
Affiliation:
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Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Arrhythmias, Cardiac / chemically induced*, drug therapy* Cardiac Glycosides / poisoning* Double-Blind Method Female Humans Immunoglobulin Fab Fragments / therapeutic use* Male Plants, Toxic / poisoning* Seeds / poisoning Sri Lanka |
| Chemical | |
Reg. No./Substance:
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0/Cardiac Glycosides; 0/Immunoglobulin Fab Fragments |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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