title: A new monospecific ovine Fab fragment antivenom for treatment of envenoming by the Sri Lankan Russell's viper (Daboia Russelii Russelii): a preliminary dose-finding and pharmacokinetic study.
abstract: Russell's viper is the most important cause of life-threatening snake bite and acute renal failure in Sri Lanka. Only equine polyspecific antivenoms imported from India are available. They have not proved effective clinically or in clearing venom antigenemia and they frequently cause reactions. In an attempt to reduce mortality and morbidity, a new monospecific ovine Fab fragment antivenom (PolongaTab; Therapeutic Antibodies, Inc., London, United Kingdom) was raised against Sri Lankan Russell's viper venom. In a preliminary dose-finding study in 35 patients, an initial dose of 3-4 g restored blood coagulability permanently and stopped systemic bleeding, even in severely envenomed patients. Venom antigenemia disappeared within 1 hr of antivenom treatment but recurred, probably as a result of continued absorption of venom from the site of the bite, after the rapid clearance of therapeutic antibody. Twelve patients (34%) experienced early reactions that were usually mild and always responded to epinephrine.
authors.affiliation: Faculty of Medicine, University of Colombo, Sri Lanka.
authors.forename: C A
authors.initials: CA
authors.lastname: Ariaratnam
authors.forename: W P
authors.initials: WP
authors.lastname: Meyer
authors.forename: G
authors.initials: G
authors.lastname: Perera
authors.forename: M
authors.initials: M
authors.lastname: Eddleston
authors.forename: S A
authors.initials: SA
authors.lastname: Kuleratne
authors.forename: W
authors.initials: W
authors.lastname: Attapattu
authors.forename: R
authors.initials: R
authors.lastname: Sheriff
authors.forename: A M
authors.initials: AM
authors.lastname: Richards
authors.forename: R D
authors.initials: RD
authors.lastname: Theakston
authors.forename: D A
authors.initials: DA
authors.lastname: Warrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D002648:Child; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000494:pharmacology*; D007928:Lethal Dose 50; D008297:Male; D051379:Mice; D008875:Middle Aged; D010599:Pharmacokinetics; D017840:Daboia; D012909:Snake Bites / Q000503:physiopathology / Q000628:therapy*; D013188:Sri Lanka; D016896:Treatment Outcome; D014757:Viper Venoms / Q000097:blood / Q000493:pharmacokinetics
chemical_list: D000997:Antivenins; D007140:Immunoglobulin Fab Fragments; D014757:Viper Venoms; D004837:Epinephrine