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. [Boyer LV, Seifert SA, Cain JS. Recurrence phenomena after immunoglobulin therapy for snake envenomations: part 2. Guidelines for clinical management with crotaline Fab antivenom. Ann Emerg Med. February 2001;37:196-201.]
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☆ Supported in part by Altana, Inc.
☆☆ Address for reprints: Leslie Boyer, MD, Arizona Poison and Drug Information Center, 1501 North Campbell Avenue, Tucson, AZ 85724; 520-626-6229, fax 520-626-2720;,E-mail boyer@pharmacy.arizona.edu .
PII: S0196-0644(01)75897-0
doi:10.1067/mem.2001.113134
© 2001 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Refers to article:
- Out-of-hospital and interhospital management of crotaline snakebite
- Role of surgical intervention in the management of crotaline snake envenomation
- Efficacy, safety, and use of snake antivenoms in the United States
- Recurrence phenomena after immunoglobulin therapy for snake envenomations: part 1. Pharmacokinetics and pharmacodynamics of immunoglobulin antivenoms and related antibodies
