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Evaluation of antivenom therapy for Vipera palaestinae bites in children: experience of two large, tertiary care pediatric hospitals.
Clin Toxicol (Phila). 2017 Apr; 55(4):235-240.CT

Abstract

BACKGROUND

Antivenom has been successfully used to treat systemic and progressive, local manifestations of envenomation inflicted by Vipera (V.) palaestinae, the most common venomous snake in Israel. The objective of this study was to evaluate the fixed dose V. palaestinae monovalent (equine) immunoglobulin G antivenom used in two pediatric emergency departments. In particular, we wanted to assess the need for repeated antivenom administration and the rate of adverse antivenom effects in children.

METHODS

A retrospective chart review was performed for all children admitted with definite or probable signs of V. palaestinae envenomation to Chaim Sheba Medical Center and Kaplan Medical Center between 1 March 2008 and 1 March 2014. Extracted data included: age, location of bite, time to hospital arrival, time to antivenom administration if indicated, outcomes, and complications of the envenomation and adverse effects to the antivenom.

RESULTS

57 patients met inclusion criteria; they ranged from 1 to 17 years in age and median age was 9.5 years. Clinical manifestations were evident in 55 (96.4%) of victims: 18 presented with minimal local signs and 37 showed marked progressive, local features (rapidly progressing edema) and signs of systemic envenomation: tachycardia (20), vomiting (17), abdominal pain (11) and hypotension (6). Two patients developed compartment syndrome and underwent surgical decompression (both received only a loading dose of antivenom with no subsequent maintenance dose). One patient developed thrombocytopenia and three patients presented with mild coagulopathy. Antivenom was administered to 25 (42%) children. Indications for antivenom administration included moderate to severe local signs (19 patients) and systemic signs (6 patients). None of these patients developed adverse reactions, serum sickness, or other side effects to the antivenom. One patient received a single additional 30mL dose of antivenom, due to hypotension and syncope, with good response.

CONCLUSIONS

In children, 50 ml dosing of V. palaestinae antivenom is efficacious and safe for the treatment of systemic and progressive local manifestations of envenomation by V. palaestinae.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Pivko-Levy D
a Division of Pediatric Emergency Medicine, Department of Pediatrics , Dana-Dwek Children Hospital, Sackler School of Medicine, University of Tel Aviv , Tel Aviv, Israel.
Munchnak I
b Division of Pediatric Emergency Medicine , Tel Hashomer Hospital , Tel Aviv , Israel.
Rimon A
a Division of Pediatric Emergency Medicine, Department of Pediatrics , Dana-Dwek Children Hospital, Sackler School of Medicine, University of Tel Aviv , Tel Aviv, Israel.
Balla U
c Division of Pediatric Emergency Medicine, Department of Pediatrics , Kaplan Medical Center, Jerusalem University , Rehovot, Israel.
Scolnik D
d Division of Clinical Pharmacology and Toxicology, Department of Pediatrics , The Hospital for Sick Children, University of Toronto , Toronto, Canada.
Hoyte C
a Division of Pediatric Emergency Medicine, Department of Pediatrics , Dana-Dwek Children Hospital, Sackler School of Medicine, University of Tel Aviv , Tel Aviv, Israel. e Denver Health and Hospital Authority , Rocky Mountain Poison and Drug Center , Denver , CO , USA.
Voliovitch Y
a Division of Pediatric Emergency Medicine, Department of Pediatrics , Dana-Dwek Children Hospital, Sackler School of Medicine, University of Tel Aviv , Tel Aviv, Israel.
Glatstein M
a Division of Pediatric Emergency Medicine, Department of Pediatrics , Dana-Dwek Children Hospital, Sackler School of Medicine, University of Tel Aviv , Tel Aviv, Israel. f Department of Emergency Medicine , School of Medicine, Anschutz Medical Center, University of Colorado , Aurora , CO , USA. g Division of Clinical Pharmacology and Toxicology , Ichilov Hospital, University of Tel Aviv, Tel Aviv, Israel.

MeSH

AdolescentAnimalsAntiveninsChildChild, PreschoolDose-Response Relationship, DrugEdemaEmergency Service, HospitalFemaleHospitals, PediatricHumansHypotensionImmunoglobulin GInfantIsraelMalePainRetrospective StudiesSnake BitesTertiary HealthcareViper VenomsViperidae

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28103732

Citation

Pivko-Levy, Dikla, et al. "Evaluation of Antivenom Therapy for Vipera Palaestinae Bites in Children: Experience of Two Large, Tertiary Care Pediatric Hospitals." Clinical Toxicology (Philadelphia, Pa.), vol. 55, no. 4, 2017, pp. 235-240.
Pivko-Levy D, Munchnak I, Rimon A, et al. Evaluation of antivenom therapy for Vipera palaestinae bites in children: experience of two large, tertiary care pediatric hospitals. Clin Toxicol (Phila). 2017;55(4):235-240.
Pivko-Levy, D., Munchnak, I., Rimon, A., Balla, U., Scolnik, D., Hoyte, C., Voliovitch, Y., & Glatstein, M. (2017). Evaluation of antivenom therapy for Vipera palaestinae bites in children: experience of two large, tertiary care pediatric hospitals. Clinical Toxicology (Philadelphia, Pa.), 55(4), 235-240. https://doi.org/10.1080/15563650.2016.1277233
Pivko-Levy D, et al. Evaluation of Antivenom Therapy for Vipera Palaestinae Bites in Children: Experience of Two Large, Tertiary Care Pediatric Hospitals. Clin Toxicol (Phila). 2017;55(4):235-240. PubMed PMID: 28103732.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of antivenom therapy for Vipera palaestinae bites in children: experience of two large, tertiary care pediatric hospitals. AU - Pivko-Levy,Dikla, AU - Munchnak,Itamar, AU - Rimon,Ayelet, AU - Balla,Uri, AU - Scolnik,Dennis, AU - Hoyte,Christopher, AU - Voliovitch,Yair, AU - Glatstein,Miguel, Y1 - 2017/01/20/ PY - 2017/1/21/pubmed PY - 2017/3/3/medline PY - 2017/1/21/entrez KW - Israel KW - Vipera palaestinae KW - antivenom KW - children KW - envenomation SP - 235 EP - 240 JF - Clinical toxicology (Philadelphia, Pa.) JO - Clin Toxicol (Phila) VL - 55 IS - 4 N2 - BACKGROUND: Antivenom has been successfully used to treat systemic and progressive, local manifestations of envenomation inflicted by Vipera (V.) palaestinae, the most common venomous snake in Israel. The objective of this study was to evaluate the fixed dose V. palaestinae monovalent (equine) immunoglobulin G antivenom used in two pediatric emergency departments. In particular, we wanted to assess the need for repeated antivenom administration and the rate of adverse antivenom effects in children. METHODS: A retrospective chart review was performed for all children admitted with definite or probable signs of V. palaestinae envenomation to Chaim Sheba Medical Center and Kaplan Medical Center between 1 March 2008 and 1 March 2014. Extracted data included: age, location of bite, time to hospital arrival, time to antivenom administration if indicated, outcomes, and complications of the envenomation and adverse effects to the antivenom. RESULTS: 57 patients met inclusion criteria; they ranged from 1 to 17 years in age and median age was 9.5 years. Clinical manifestations were evident in 55 (96.4%) of victims: 18 presented with minimal local signs and 37 showed marked progressive, local features (rapidly progressing edema) and signs of systemic envenomation: tachycardia (20), vomiting (17), abdominal pain (11) and hypotension (6). Two patients developed compartment syndrome and underwent surgical decompression (both received only a loading dose of antivenom with no subsequent maintenance dose). One patient developed thrombocytopenia and three patients presented with mild coagulopathy. Antivenom was administered to 25 (42%) children. Indications for antivenom administration included moderate to severe local signs (19 patients) and systemic signs (6 patients). None of these patients developed adverse reactions, serum sickness, or other side effects to the antivenom. One patient received a single additional 30mL dose of antivenom, due to hypotension and syncope, with good response. CONCLUSIONS: In children, 50 ml dosing of V. palaestinae antivenom is efficacious and safe for the treatment of systemic and progressive local manifestations of envenomation by V. palaestinae. SN - 1556-9519 UR - https://www.unboundmedicine.com/medline/citation/28103732/Evaluation_of_antivenom_therapy_for_Vipera_palaestinae_bites_in_children:_experience_of_two_large_tertiary_care_pediatric_hospitals_ DB - PRIME DP - Unbound Medicine ER -