Tiger Snake Antivenom

Tiger Snake antivenom (equine IgG Fab) can be used to treat envenomation from the Tiger snakes in Australia, these include the Common and western Tiger snake, Stephen’s banded snake, pale-headed snake, broad-headed snake, rough-scaled snake, copperhead snake and the small-eyed snake

Indication:

  • Clinical evidence of envenomation
  • Tiger snake and rough-scaled snake: laboratory evidence of complete or partial venom-induced consumptive coagulopathy (VICC), neurotoxicity and myotoxicity
  • Copperhead: paralysis and occasional myotoxicity
  • Pale-headed and broad-headed snake: VICC but not paralysis or myotoxocity
  • Small-eyed snake – 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)

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:

  • Tiger snake antivenom halts the progression of paralysis but established neurotoxicity is not reversed
  • Envenoming by the Hoplocephalus spp (Stephen’s banded snake, pale-headed snake and broad-headed snake) resemble that of the brown snake and therefore it is possible to give brown snake antivenom in these particular cases if no tiger is available
  • 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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