However, there is dearth of data regarding successful use of such therapies. of accidental overdose leading to toxicity. Moreover, as it is definitely widely and easily available, it has got a significant abuse potential and may be used for suicidal purposes.[1] Recently, digoxin-specific antibody (Fab) fragments have been shown to be effective in safely and quickly eliminating digoxin from blood and reduce mortality and hence, have become the mainstay of therapy in individuals with digoxin toxicity.[2,3] However, it is not widely available, especially in countries like India, where only traditional symptomatic therapy may be offered to individuals with digoxin toxicity. Due to high mortality associated with severe digoxin toxicity it becomes imperative that additional alternative approaches may be tried to improve outcome. However, there is dearth of data concerning successful use of such therapies. Here we present a case of suicidal ingestion of large quantities of digoxin which was efficiently managed by using resin hemofilteration in the absence of Fab fragments. Case Statement A 30 yr old female offered to casualty with an alleged history of ingestion of 70 tablets of 0.25 mg digoxin (total dose 17.5 mg) one hour prior to demonstration. She had developed nausea and recurrent vomiting 20 moments after ingestion. Immediate gastric lavage was carried out and triggered charcoal 100 gm was given through nasogastric tube. One gram magnesium sulphate was also given intravenously. On exam, she was conscious, oriented, afebrile, and experienced a heart rate of 102/ minute, BP of 106/70 mmHg, respiratory rate of 20/ minute, and was keeping oxygen saturation of 99% on space air. Systemic exam was unremarkable and her initial electrocardiograph showed normal sinus rhythm. All routine laboratory tests were sent along with serum digoxin levels and urine toxicology display. She was immediately shifted to ICU. Initial investigations exposed serum digoxin levels of 12.63 ng/ml (normal range 0.8- 2.0 ng/ml), serum calcium 8.3 mg/dl, potassium 4.6 mmol/L, sodium 137 mmol/L, magnesium BBT594 3.13 mg/dl, and a normal hemogram, liver and renal function checks. She experienced prolonged vomiting and also developed diplopia, blurring and yellowing of vision within two hours of admission along with intermittent episodes of bradycardia along with hypotension (systolic BP up to 70 mmHg). Electrocardiographs in the beginning showed variable and long term PR [Number 1] with atrial ectopics, which consequently converted into total heart block. Prophylactically transcutaneous pacing was applied to gain time for temporary pacemaker insertion as the patient continued to have episodes of symptomatic bradycardia (heart rate going down up to 30/minute). Immediate cardiology opinion was taken and temporary pacemaker was put [Number 2]. In view of high serum digoxin levels, presence of bradyarrhythmias with hypotension and nonavailability of Fab fragments, hemoperfusion with resin-based cartridge (HA280 resin hemoperfusion cartridge, Jafron Biomedical Co. Ltd., China) was carried out over 4 hours after taking nephrology opinion and written informed consent from your attendants. Lack of adequate literature about BBT594 security and effectiveness of the procedure were cautiously PF4 explained to the attendants. Patient was closely observed and platelets, coagulation profile, serum electrolytes and digoxin levels [Table 1] were monitored regularly. Patient tolerated the procedure well and there were no associated side effects, fall in platelet levels or procedure-related complications. Open in a separate window Number 1 Electrocardiograph showing prolonged and varying PR interval (arrows) Open in a separate window Number 2 Chest X-ray showing external pacing pads (black arrows) and temporary internal pacemaker (white arrow) Table 1 Serum digoxin levels during resin hemoperfusion Open in BBT594 a separate window.