title: Low dose of snake antivenom is as effective as high dose in patients with severe neurotoxic snake envenoming.
abstract: The objective of this study was to evaluate the effects of two different dosage protocols on the outcome of patients with severe neurotoxic snake envenoming, using a retrospective analysis of patients admitted with a diagnosis of severe neurotoxic snake bite over a 4 year period. In the study, 55 snake bite victims requiring ventilatory support for severe neurotoxic envenoming received either 150 ml of polyvalent snake antivenom (SAV) (low dose SAV group, n = 28) or 100 ml of SAV at presentation followed by 100 ml every 6 hours until recovery of neurological manifestations (high dose group, n = 27). The median dose of SAV in the high dose group was 600 ml (range 300 to 1600). The duration of mechanical ventilation in the low dose group (median 47.5 hours; range 14 to 248) was similar to that in the high dose group (median 44 hours; range 6 to 400). The mean (SD) duration of intensive care unit stay was similar in the two groups. There were three deaths in the high dose group; two patients in the low dose group had neurological sequelae. All other patients improved, had no residual neurological deficit, and were discharged. We conclude that there is no difference between a protocol using lower doses of SAV and one with higher doses in the management of patients with severe neurotoxic snake envenoming.
authors.affiliation: Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. drritesh1@rediffmail.com
authors.forename: R
authors.initials: R
authors.lastname: Agarwal
authors.forename: A N
authors.initials: AN
authors.lastname: Aggarwal
authors.forename: D
authors.initials: D
authors.lastname: Gupta
authors.forename: D
authors.initials: D
authors.lastname: Behera
authors.forename: S K
authors.initials: SK
authors.lastname: Jindal
mesh_terms: D000328:Adult; D000997:Antivenins / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004630:Emergencies; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D009498:Neurotoxins / Q000506:poisoning; D012189:Retrospective Studies; D012909:Snake Bites / Q000188:drug therapy*; D012910:Snake Venoms / Q000506:poisoning*; D016896:Treatment Outcome
chemical_list: D000997:Antivenins; D009498:Neurotoxins; D012910:Snake Venoms