title: Recurrence phenomena after immunoglobulin therapy for snake envenomations: Part 2. Guidelines for clinical management with crotaline Fab antivenom.
abstract: Recurrent local and coagulopathic effects (worsening after clinical improvement) have been described after treatment with Fab antivenom for envenomation by North American crotaline snakes. Although similar phenomena have been described previously in snakebite, few studies have examined recurrence or its management. Recurrence is consistent with known venom and antivenom kinetics and dynamics. The clinical significance of late coagulopathy after snakebite is uncertain, but clinically significant bleeding is a possibility. Prevention and treatment of recurrence with Fab antivenom require repeated dosing for at least 18 hours, with close monitoring of at-risk patients in the follow-up period. Duration of therapy depends on individual risk factors and coagulation response.
authors.affiliation: Department of Pediatrics and Arizona Poison and Drug Information Center, University of Arizona Health Sciences Center, Tucson, AZ 85724, USA. boyer@pharmacy.arizona.edu
authors.forename: L V
authors.initials: LV
authors.lastname: Boyer
authors.forename: S A
authors.initials: SA
authors.lastname: Seifert
authors.forename: J S
authors.initials: JS
authors.lastname: Cain
mesh_terms: D000359:Aftercare / Q000379:methods; D000465:Algorithms; D000818:Animals; D000997:Antivenins / Q000009:adverse effects* / Q000378:metabolism; D001778:Blood Coagulation Disorders / Q000209:etiology* / Q000517:prevention & control*; D003663:Decision Trees; D018450:Disease Progression; D016903:Drug Monitoring / Q000379:methods; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects* / Q000378:metabolism; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012307:Risk Factors; D012909:Snake Bites / Q000097:blood / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D017819:Viperidae / Q000276:immunology
chemical_list: D000997:Antivenins; D007140:Immunoglobulin Fab Fragments