Taipan Antivenom

Taipan antivenom (equine IgG Fab) can be used to treat envenomation from the Taipan snakes in Australia and Papua New Guinea, these include the Costal Taipan, Papuan Taipan and the small-scaled or fierce snake

Indication:

  • Clinical evidence of envenomation including neurotoxicity
  • Laboratory evidence of complete or partial venom-induced consumptive coagulopathy (VICC) and myotoxicity

Contraindication:

  • No absolute
  • Increased Risk of anaphylaxis in patients previously treated with antivenom or those who are suspected of equine sera allergy

Administration:

  • Place the patient in a monitored area where anaphylaxis can be managed
  • Administer 1 ampoule diluted in 500ml of 0.9% saline IV over 20 minutes (the dose is the same for adults and paediatrics – snakes don’t envenomate less because its a child)
  • Can be given as a rapid IV push if the patient is haemodynamically unstable or in cardiac arrest.

Adverse drug reactions:

  • Anaphylaxis: Cease antivenom infusion, treat as per anaphylaxis with oxygen, IV fluids and IM adrenaline. Recommence antivenom infusion when anaphylaxis has resolved. Rarely will ongoing administration of adrenaline be required to complete the antivenom infusion.
  • Serum Sickness: A benign and self limiting complication occurs 5-10 days after antivenom, symptoms include fever, rash, arthralgia and myalgia. Oral steroids for 5 days may ameliorate symptoms (e.g. prednisolone 50mg/day in adults and 1mg/kg in children). All patients should be warned about this complication who receive antivenom.

Controversies and Top Tips:

  • Taipan antivenom halts the progression of paralysis but established neurotoxicity is not reversed, also recent evidence suggests that the antivenom does not hasten the recovery of VICC but may prevent/reverse other manifestations of envenomation.
  • One ampoule of Polyvalent antivenom may be used instead but at increased risk for anaphylaxis
  • The use of Fresh Frozen Plasma or Cryoprecipitate: When used after antivenom has been associated with a quicker recovery of VICC but not with earlier hospital discharge. The use of these products in envenomation has not been well defined and should be used at the recommendation of a toxicologist.

References


toxicology library antidote 700 1

Toxicology Library

ANTIVENOM

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Burnaby Hospital in Vancouver Emergency. Loves the misery of alpine climbing and working in austere environments. Supporter of FOAMed, toxicology, tropical medicine, sim and ultrasound

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