Anti Snake Venom

 

Ms. Liya John

Department of Medical Surgical Nursing, MGM New Bombay College of Nursing, Kamothe, Navi Mumbai

 

ABSTRACT:

ASV is the only definitive treatment of snake bite to neutralize venom in circulation and in the tissue fluid. The primary indication of ASV administration is incoagulable blood or neurological deficit at early period of snake bite. The polyvalent ASV acts against all four commom poisonous snakes is preferred as difficulty in identification of species of snakes.

 

 

INTRODUCTION:

a.      Neurotoxicity

b.      Bleeding/coagulopathy

c.      Myoglobinuria

d.      Cardiac toxicity

e.      Local swelling involving more than half of the bitten limb

f.       Development of enlarged tendor lymph node draining the bitten limb

g.      Acute Renal failure

 

Dose:

In mild case 5 vial, in moderate case 5 to 10 vial and in severe case 10-20 vial

 

Mode of Administration:

a.    ASV is given slowly as IV injection or infusion at rate of 2ml/min

b.    ASV should never give locally at site of snake bite

 

For Supportive Therapy:

a.      Coagulopathy- if it doesnot reverse after ASV therapy FFP, Cryoprecipitate, Whole Blood, Platelet Concentrate

b.      Bulbar Paralysis- ASV alone not sufficient Tracheostomy, endotracheal intubation, mechanical ventilation Inj neostigmine: 50-100ugm/kg/4 hours as continous infusion

c.      Glycopyyrrolate About 0.25 mg can be given before neostigmine in place of atropine as glycopyrolate doesnot cross blood brain barrier

d.      Patients with clear ,objective evidence of neurotoxicity after snake bite should receive a trial of edrophonium or neostigmine

i.       Pretreat with atropine:0.6mg/IV

ii.      Follow with: Neostigmine:1.5-2mg IM or Edrophonium: 10mg IV

iii.    If objective improvement is evident at 5 min, continue neostigmine at adose    of 0.5mg every 30 min as needed with continued administration of atropine 0.6 mg over 8 hr

e.      Care of bitten part: Antibiotic prophylaxis and tetanus toxoid

 

Treatment of Adverse Reaction of anti snake venom:

a.      Discontinue ASV

b.      Adrenaline 0.5 mg/kg.it can be repeated every 5min if necessary

c.      Chlophenarimine maleate IV 1mg

d.      Hydrocortisone IV

                                                                                                                                                                   

CONCLUSION:

The antisnake venom is specific antidote for venomous snake bite. ASV should be used only when there is possibility of circulating venom in the body and not to all snake bite cases.ASV is highly effective but liable to cause severe adverse  reaction including anaphylaxis. The timely approach to manage these reaction creates a simple solution.

 

REFERENCES:

1.       Amin MR, Mamun SMH. etal. Anti snake venom use and adverse reaction in a snake bite study clinic in Bangladesh. J. Venom.  Anim.Toxins incl Trop.Dis.14 (4).2008

2.       Guidelines for Anti Snake Venom Therapy. Medicine Update.20.2010

3.       Tripati KD. Essentials of Medical Pharmacology.6 th Ed. Jaypee Publishers.2008

 

 

 

Received on 08.09.2018           Modified on 10.10.2018

Accepted on 20.10.2018     © A&V Publications all right reserved