Extracorporeal life support and digoxin-specific Fab fragments for successful management of Taxus baccata intoxication with low output and ventricular arrhythmia
Yew plants are evergreen shrubs which are widely spread throughout the northern hemisphere. Taxane alkaloid derivatives, mainly taxine B, represent the main toxins of Taxus baccata and are highly cardiotoxic. Due to the lack of randomized clinical trials, case reports on accidental or suicidal yew i...
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| Main Authors: | , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
18 September 2017
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| In: |
The American journal of emergency medicine
Year: 2017, Volume: 35, Issue: 12, Pages: 1987.e3-1987.e7 |
| ISSN: | 1532-8171 |
| DOI: | 10.1016/j.ajem.2017.09.031 |
| Online Access: | Resolving-System, Volltext: http://dx.doi.org/10.1016/j.ajem.2017.09.031 Verlag, Volltext: http://www.sciencedirect.com/science/article/pii/S0735675717307568 
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| Author Notes: | Mina Farag, Dominika Badowski, Ronald Koschny, Gisela Skopp, Andreas Brcic, Gabor B. Szabo |
| Summary: | Yew plants are evergreen shrubs which are widely spread throughout the northern hemisphere. Taxane alkaloid derivatives, mainly taxine B, represent the main toxins of Taxus baccata and are highly cardiotoxic. Due to the lack of randomized clinical trials, case reports on accidental or suicidal yew intoxications build the only source of knowledge of clinical treatment options. We report the case of a suicidal yew ingestion admitted to our hospital under prolonged cardiopulmonary resuscitation due to pulseless electrical activity. Extra-corporeal life support (ECLS) was established to maintain adequate organ perfusion. Repeated administration of digoxin-specific Fab antibody fragments, which cross-react with taxine, was associated with an immediate conversion from asystole to broad-complex bradycardia and a gradual normalization of the electrocardiogram (ECG). This was paralleled by a recovery of the cardiac function and weaning from the ECLS. The taxine metabolite 3,5-dimethoxyphenol could be detected by mass spectrometry before but not after the first Fab-fragment treatment. In contrast, the total amount of taxine (including the neutralized, Fab fragment-bound fraction) was increased after each Fab fragment administration, suggesting an accumulation of neutralized, since antibody-bound taxine in the blood by anti-digoxin Fab fragments. |
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| Item Description: | Gesehen am 23.11.2018 |
| Physical Description: | Online Resource |
| ISSN: | 1532-8171 |
| DOI: | 10.1016/j.ajem.2017.09.031 |