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If the rhythm disturbance is a symptomatic bradyarrhythmia or heart block, consideration should be given to the reversal of toxicity with digibind digoxin immune fab ovine see massive digitalis overdosage subsection , the use of atropine, or the insertion of a temporary cardiac pacemaker.

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papain is used to cleave the whole antibody into fab and fc fragments, and traces of papain or inactivated papain residues may be present in digibind digoxin immune fab .

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17,18 a massive digoxin overdose may result in hyperkalemia that should be treated promptly i.


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