ASV Dosage in Victims Requiring Life Saving Surgery
In very rare case of snake bite life saving surgery is required in order to save the
victim. An example would be a patient who presents with signs of an intracranial
bleed. Before surgery can take place, coagulation must be restored in the victim in
order to avoid catastrophic bleeding. In such cases a higher initial dose of ASV is
justifi ed (upto 25 vials) solely on the basis of guaranteeing restoration of coagulation
after 6 hours.
Victims Who Arrive Late
A frequent problem is victims who arrive late after the bite, often after several
days, usually with acute renal failure. Should the clinician administer ASV? The key
determining factor is, are there any signs of current venom activity? Venom can only be
neutralised, if it is unattached! Perform a 20 WBCT and determine if any coagulopathy
is present. If coagulopathy is present, administer ASV. If no coagulopathy is evident,
assess the case for evidences for one or other complications and consequences secondary
to complication of snake bite. Such cases require appropriate supportive measures.
In the case of neurotoxic envenoming where the victim is having symptoms such
as ptosis, respiratory failure etc, it is probably wise to administer one dose of 8-10 vials
of ASV to ensure that no unbound venom is present. However, at this stage it is likely
that all the venom is bound and patient requires respiratory support.
Snake bites Again!
If a patient has been bitten by a poisonous snake and received ASV earlier and
comes back with features of repeat snake bite, he / she may be considered as a fresh
case and treated accordingly (Whatever the interval between the snakebite). However,
care should be taken while administering ASV, since he / she has been sensitised.
Pregnancy and Lactating woman
There is very little defi nitive data published on the effects of snakebite during
pregnancy. Though spontaneous abortion of the foetus has been reported, this is not the outcome in the majority of cases. It is not clear if venom can pass the placental
barrier. Pregnant women are treated in exactly the same way as other victims. The
same dosage of ASV is given. The victim should be re-assessed for the impact on the
fetus. One should be alert and rule out retro placental clot. The effects of venom and
antivenom on the mother and fetus need further exploration. ASV may be administered
to lactating woman if bitten by a poisonous snake and be treated like any other persons.
Breast feeding is not contraindicated.
Others:
Even if the patients belong to any of the following category viz., autoimmune
disorders, debilitating status, endocrine disorders, Immuno-suppressed status, HIV/
AIDS, cancer, asthma and allergic disorders or any other illness arrive with features of
snake envenomation, they also require ASV in the same manner like any other case of
poisonous snake bite.