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Antivenom dosing in 35 patients with severe brown snake (Pseudonaja) envenoming in Western Australia over 10 years.
Med J Aust. 2004 Dec 6-20; 181(11-12):703-5.MJ

Abstract

OBJECTIVE

To investigate the doses of antivenom administered to adult patients with severe brown snake envenoming.

DESIGN AND SETTING

Review of charts from Western Australian adult teaching hospitals, December 1991 to December 2001.

PATIENTS

35 patients with severe brown snake envenoming, defined prospectively as afibrinogenaemia (< 0.3 g/L) after a bite by a brown snake (genus Pseudonaja).

MAIN OUTCOME MEASURE

The dose of antivenom required to neutralise venom, defined prospectively as the dose of antivenom given before the return of detectable fibrinogen levels.

RESULTS

Of 88 patients with brown snake envenoming admitted over the 10 years, at least 35 had severe envenoming. Afibrinogenaemia persisted for 10 hours (range, 1.4-68 hours) after the first dose of antivenom; in four patients afibrinogenaemia lasted more than 24 hours. The dose of antivenom given before venom neutralisation ranged from one to 23 ampoules. In two-thirds of cases, venom was neutralised with five ampoules, and 89% had venom neutralised with 10 ampoules. Two patients died, and another had serious bleeding complications. Another patient died during the study period from intracerebral haemorrhage, but did not have fibrinogen levels measured.

CONCLUSIONS

Patients received initial doses of antivenom too small to neutralise circulating venom, and remained afibrinogenaemic for prolonged periods, with serious consequences. The authors now use 10 ampoules as an initial dose in severe brown snake envenoming.

Authors+Show Affiliations

Department of Emergency Medicine, Royal Perth Hospital, University of Western Australia, Perth, WA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15588174

Citation

Yeung, Justin M., et al. "Antivenom Dosing in 35 Patients With Severe Brown Snake (Pseudonaja) Envenoming in Western Australia Over 10 Years." The Medical Journal of Australia, vol. 181, no. 11-12, 2004, pp. 703-5.
Yeung JM, Little M, Murray LM, et al. Antivenom dosing in 35 patients with severe brown snake (Pseudonaja) envenoming in Western Australia over 10 years. Med J Aust. 2004;181(11-12):703-5.
Yeung, J. M., Little, M., Murray, L. M., Jelinek, G. A., & Daly, F. F. (2004). Antivenom dosing in 35 patients with severe brown snake (Pseudonaja) envenoming in Western Australia over 10 years. The Medical Journal of Australia, 181(11-12), 703-5.
Yeung JM, et al. Antivenom Dosing in 35 Patients With Severe Brown Snake (Pseudonaja) Envenoming in Western Australia Over 10 Years. Med J Aust. 2004 Dec 6-20;181(11-12):703-5. PubMed PMID: 15588174.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antivenom dosing in 35 patients with severe brown snake (Pseudonaja) envenoming in Western Australia over 10 years. AU - Yeung,Justin M, AU - Little,Mark, AU - Murray,Lindsay M, AU - Jelinek,George A, AU - Daly,Frank F S, PY - 2004/04/30/received PY - 2004/09/30/accepted PY - 2004/12/14/pubmed PY - 2005/3/15/medline PY - 2004/12/14/entrez SP - 703 EP - 5 JF - The Medical journal of Australia JO - Med J Aust VL - 181 IS - 11-12 N2 - OBJECTIVE: To investigate the doses of antivenom administered to adult patients with severe brown snake envenoming. DESIGN AND SETTING: Review of charts from Western Australian adult teaching hospitals, December 1991 to December 2001. PATIENTS: 35 patients with severe brown snake envenoming, defined prospectively as afibrinogenaemia (< 0.3 g/L) after a bite by a brown snake (genus Pseudonaja). MAIN OUTCOME MEASURE: The dose of antivenom required to neutralise venom, defined prospectively as the dose of antivenom given before the return of detectable fibrinogen levels. RESULTS: Of 88 patients with brown snake envenoming admitted over the 10 years, at least 35 had severe envenoming. Afibrinogenaemia persisted for 10 hours (range, 1.4-68 hours) after the first dose of antivenom; in four patients afibrinogenaemia lasted more than 24 hours. The dose of antivenom given before venom neutralisation ranged from one to 23 ampoules. In two-thirds of cases, venom was neutralised with five ampoules, and 89% had venom neutralised with 10 ampoules. Two patients died, and another had serious bleeding complications. Another patient died during the study period from intracerebral haemorrhage, but did not have fibrinogen levels measured. CONCLUSIONS: Patients received initial doses of antivenom too small to neutralise circulating venom, and remained afibrinogenaemic for prolonged periods, with serious consequences. The authors now use 10 ampoules as an initial dose in severe brown snake envenoming. SN - 0025-729X UR - https://www.unboundmedicine.com/medline/citation/15588174/Antivenom_dosing_in_35_patients_with_severe_brown_snake__Pseudonaja__envenoming_in_Western_Australia_over_10_years_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=15588174.ui DB - PRIME DP - Unbound Medicine ER -