Management of Snakebite and Research Management of Snakebite ...

Management of Snakebite and Research
50
Hence, the following conclusions and recommendations were made as a guidelines
for antivenom therapy in Russell’s Viper bite patients.
CONCLUSIONS
Table 6. Clinical features in regime one on admission
(comparing patients receiving 40 ml and 40 + 40 ml ASV).
(1) 40 ml of monovalent antivenom of Russell’s viper was sufficient in 48% of
envenomed patients without systemic bleeding or heavy proteinuria (+ 3 and
above) on admission.
(2) 33% of patients with systemic bleeding and 75% of patients with proteinuria
(+3 and above) needed a bolus dose of 80 ml.
(3) Patients who had received 40 ml needed another dose of 40 ml to correct the
coagulation defect if they developed systemic bleeding and or heavy proteinuria
or if blood failed to reclot six hours after the initial dose.
(4) There was no reduction in the incidence of acute renal failure by increasing the
dose to 80 ml.
RECOMMENDATIONS
40 ml ASV 40 + 40 ml ASV
Local swelling number of cases 8 11
Increase in circumference (mean SEM) 5.6 + 7 3.6 + 3
Regional lymphadenitis (no. of cases) 10 10
Systemic bleeding (no. of cases) nil 4
Gum nil 2
Haematemesis and malaena nil 3
Total white cell count/ cumm (mean) 40 660 29 425
Platelet count/cumm (mean) 363 500 257 222
Urine protein (no. of cases)
Proteinuria < plus 3
Proteinuria plus 3>
Microscopic harmaturia
RBC 50 (+1)
Rbc numerous
(1) An initial bolus dose of 40 ml is recommended for envenomed patients without
any systemic bleeding or heavy proteinuria on admission.
6
1
2
2
2
8
7
1