SHORT REPORT

Low dose of snake antivenom is as effective as high dose in patients with severe neurotoxic snake envenoming

R Agarwal, A N Aggarwal, D Gupta, D Behera, S K Jindal

Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence to:
Correspondence to:
Dr R Agarwal
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India; drritesh1{at}rediffmail.com

The objective of this study was to evaluate the effects of two different dosage protocols on the outcome of patients with severe neurotoxic snake envenoming, using a retrospective analysis of patients admitted with a diagnosis of severe neurotoxic snake bite over a 4 year period. In the study, 55 snake bite victims requiring ventilatory support for severe neurotoxic envenoming received either 150 ml of polyvalent snake antivenom (SAV) (low dose SAV group, n = 28) or 100 ml of SAV at presentation followed by 100 ml every 6 hours until recovery of neurological manifestations (high dose group, n = 27). The median dose of SAV in the high dose group was 600 ml (range 300 to 1600). The duration of mechanical ventilation in the low dose group (median 47.5 hours; range 14 to 248) was similar to that in the high dose group (median 44 hours; range 6 to 400). The mean (SD) duration of intensive care unit stay was similar in the two groups. There were three deaths in the high dose group; two patients in the low dose group had neurological sequelae. All other patients improved, had no residual neurological deficit, and were discharged. We conclude that there is no difference between a protocol using lower doses of SAV and one with higher doses in the management of patients with severe neurotoxic snake envenoming.

Abbreviations: RICU, respiratory intensive care unit; SAV, snake antivenom

Keywords: neurotoxic snakebite; snake antivenom dose; mechanical ventilation

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