{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:24:24Z","timestamp":1777940664972,"version":"3.51.4"},"reference-count":14,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of the Royal College of Physicians of Edinburgh"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:p>Digoxin toxicity can be life-threatening. Digoxin-specific antibody (DSA) fragments are used in severe digoxin toxicity, binding to serum-free digoxin and enabling increased renal excretion. In severe renal impairment, clearance of these complexes is prolonged, leading to rebound toxicity. Digoxin and DSA complexes are not dialysable. We present a case of a gentleman with severe digoxin toxicity and acute kidney injury (AKI). Despite receiving DSA doses, his digoxin levels rebounded and symptoms persisted. Based on published case reports, plasma exchange (PEX) after further dosing was arranged. PEX facilitated the removal of digoxin\u2013DSA complexes, bypassing renal excretion. During PEX, clinical signs improved and were sustained. He did not require further dialysis or PEX, renal function recovered and he was discharged. This case highlights challenges in the management of severe digoxin toxicity in patients with a concurrent AKI. The use of PEX enabled digoxin\u2013DSA complex removal and should be considered in these circumstances.<\/jats:p>","DOI":"10.1177\/14782715241239372","type":"journal-article","created":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T22:59:44Z","timestamp":1710802784000},"page":"55-58","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Plasma exchange for the management of digoxin toxicity in an individual with an acute kidney injury: A case report"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8020-0800","authenticated-orcid":false,"given":"Hannah","family":"Preston","sequence":"first","affiliation":[{"name":"The Department of Renal Medicine, The Royal Infirmary of Edinburgh, Little France, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Cannon","sequence":"additional","affiliation":[{"name":"The Department of Renal Medicine, The Royal Infirmary of Edinburgh, Little France, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Watson","sequence":"additional","affiliation":[{"name":"NHS Lothian, The Department of Renal Medicine, The Royal Infirmary of Edinburgh, Little France, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,3,18]]},"reference":[{"key":"e_1_3_3_2_2","article-title":"The effect of digoxin on mortality and morbidity in patients with heart failure","volume":"336","author":"Digitalis Investigation Group","year":"1997","unstructured":"Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 1997; 336: 525\u201333.","journal-title":"N Engl J Med"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/039139880202500608"},{"key":"e_1_3_3_4_2","article-title":"Combined use of plasmapheresis and antidigoxin antibodies in a patient with severe digoxin intoxication and acute renal failure","volume":"22","author":"Santos-Araujo C","year":"2007","unstructured":"Santos-Araujo C, Campos M, Gavina C, et al. Combined use of plasmapheresis and antidigoxin antibodies in a patient with severe digoxin intoxication and acute renal failure. Nephrol Dial Transplant 2007; 22: 257\u20138.","journal-title":"Nephrol Dial Transplant"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1053\/ajkd.2000.8291"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1159\/000168179"},{"key":"e_1_3_3_7_2","unstructured":"Joint Formulary Committee. Digoxin. British National Formulary (online). London: BMJ and Pharmaceutical Press http:\/\/medicinescomplete.com (accessed 05 December 2023)."},{"key":"e_1_3_3_8_2","unstructured":"Medicines.org. Digoxin. [internet] https:\/\/www.medicines.org.uk\/emc\/product\/5465\/smpc#gref (2022 accessed 05 December 2023)."},{"key":"e_1_3_3_9_2","volume-title":"Digoxin Immune Fab","author":"Hassan SA","year":"2023","unstructured":"Hassan SA, Goyal A. Digoxin Immune Fab. StatPearls. Treasure Island (FL); 2023."},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.81.6.1744"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.1999.07202.x"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-197702010-00001"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/20543581211067090"},{"key":"e_1_3_3_14_2","unstructured":"Renal Drug Database. 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