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Effect of antivenin dose on outcome from crotalid envenomation: 218 dogs (1988-2006).
J Vet Emerg Crit Care (San Antonio). 2009 Dec; 19(6):603-10.JV

Abstract

OBJECTIVE

To determine whether the dose of antivenin administered is associated with a difference in survival of crotalid-envenomated dogs. A secondary objective was to determine whether other covariables affect survival.

DESIGN

Retrospective study (1988-2006).

SETTING

Private referral center and university small animal teaching hospital.

ANIMALS

Two hundred and eighteen dogs with evidence of crotalid envenomation and treatment with equine-derived antivenin.

INTERVENTIONS

Administration of antivenin.

MEASUREMENTS AND MAIN RESULTS

Patient signalment, physical and clinicopathologic data at time of presentation, treatments, complications of antivenin therapy, length and cost of hospitalization, and outcome were recorded. Confidence intervals were determined for the difference in median number of vials administered and for median dosage for patients that lived versus died. Penalized logistic regression was performed to evaluate the effect of other covariables on survival. The median age of affected dogs was 3 years (range 6 w-12 y) with a median weight of 25.7 kg (range 1.95-86.4 kg). The median number of antivenin vials administered was 1.0 (range 1.0-10.0). Acute and chronic reactions were reported in 7% (16/218) and 0.9% (2/218) of dogs, respectively. Nine of 218 dogs (4.1%) died. The median number of vials administered to the nonsurvivors and survivors were 2.0 (range 1-5 vials) and 1.0 (range 1-10 vials), respectively. The median number of vials received was significantly different in dogs that died versus those that lived (P<0.05). Increased heart rate (P=0.02) and petechiation (P=0.04) were associated with decreased likelihood of survival, while diphenhydramine (P=0.02) and fluoroquinolone (P=0.046) administration was associated with increased likelihood of survival. The median duration of hospitalization was 1.0 day (range 2 h-22 d). The median cost of hospitalization was US$1592.00 (range US$267.20-US$6738.00).

CONCLUSION

The administration of more vials of antivenin is potentially associated with negative outcome; however, a causal relationship has not been established. Controlled, prospective studies are needed to optimize antivenin administration.

Authors+Show Affiliations

Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA. jlmccown@petsreferralcenter.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20017766

Citation

McCown, Jennifer L., et al. "Effect of Antivenin Dose On Outcome From Crotalid Envenomation: 218 Dogs (1988-2006)." Journal of Veterinary Emergency and Critical Care (San Antonio, Tex. : 2001), vol. 19, no. 6, 2009, pp. 603-10.
McCown JL, Cooke KL, Hanel RM, et al. Effect of antivenin dose on outcome from crotalid envenomation: 218 dogs (1988-2006). J Vet Emerg Crit Care (San Antonio). 2009;19(6):603-10.
McCown, J. L., Cooke, K. L., Hanel, R. M., Jones, G. L., & Hill, R. C. (2009). Effect of antivenin dose on outcome from crotalid envenomation: 218 dogs (1988-2006). Journal of Veterinary Emergency and Critical Care (San Antonio, Tex. : 2001), 19(6), 603-10. https://doi.org/10.1111/j.1476-4431.2009.00487.x
McCown JL, et al. Effect of Antivenin Dose On Outcome From Crotalid Envenomation: 218 Dogs (1988-2006). J Vet Emerg Crit Care (San Antonio). 2009;19(6):603-10. PubMed PMID: 20017766.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of antivenin dose on outcome from crotalid envenomation: 218 dogs (1988-2006). AU - McCown,Jennifer L, AU - Cooke,Kirsten L, AU - Hanel,Rita M, AU - Jones,Galin L, AU - Hill,Richard C, PY - 2009/12/19/entrez PY - 2009/12/19/pubmed PY - 2010/4/23/medline SP - 603 EP - 10 JF - Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001) JO - J Vet Emerg Crit Care (San Antonio) VL - 19 IS - 6 N2 - OBJECTIVE: To determine whether the dose of antivenin administered is associated with a difference in survival of crotalid-envenomated dogs. A secondary objective was to determine whether other covariables affect survival. DESIGN: Retrospective study (1988-2006). SETTING: Private referral center and university small animal teaching hospital. ANIMALS: Two hundred and eighteen dogs with evidence of crotalid envenomation and treatment with equine-derived antivenin. INTERVENTIONS: Administration of antivenin. MEASUREMENTS AND MAIN RESULTS: Patient signalment, physical and clinicopathologic data at time of presentation, treatments, complications of antivenin therapy, length and cost of hospitalization, and outcome were recorded. Confidence intervals were determined for the difference in median number of vials administered and for median dosage for patients that lived versus died. Penalized logistic regression was performed to evaluate the effect of other covariables on survival. The median age of affected dogs was 3 years (range 6 w-12 y) with a median weight of 25.7 kg (range 1.95-86.4 kg). The median number of antivenin vials administered was 1.0 (range 1.0-10.0). Acute and chronic reactions were reported in 7% (16/218) and 0.9% (2/218) of dogs, respectively. Nine of 218 dogs (4.1%) died. The median number of vials administered to the nonsurvivors and survivors were 2.0 (range 1-5 vials) and 1.0 (range 1-10 vials), respectively. The median number of vials received was significantly different in dogs that died versus those that lived (P<0.05). Increased heart rate (P=0.02) and petechiation (P=0.04) were associated with decreased likelihood of survival, while diphenhydramine (P=0.02) and fluoroquinolone (P=0.046) administration was associated with increased likelihood of survival. The median duration of hospitalization was 1.0 day (range 2 h-22 d). The median cost of hospitalization was US$1592.00 (range US$267.20-US$6738.00). CONCLUSION: The administration of more vials of antivenin is potentially associated with negative outcome; however, a causal relationship has not been established. Controlled, prospective studies are needed to optimize antivenin administration. SN - 1476-4431 UR - https://www.unboundmedicine.com/medline/citation/20017766/Effect_of_antivenin_dose_on_outcome_from_crotalid_envenomation:_218_dogs__1988_2006__ L2 - https://doi.org/10.1111/j.1476-4431.2009.00487.x DB - PRIME DP - Unbound Medicine ER -