ABSTRACT
A controlled clinical trial of low dose heparin was carried out in confirmed cases of Russell's viper bite. Twenty patients with systemic envenoming were included in the study. They were randomized to receive low dose heparin in an initial dose of 50 units/kg body weight intravenously immediately after antivenom followed by a continuous infusion of 10 unit 3 kg/hour in isotonic saline for 24 hours, or antivenom alone. Response to treatment was assessed clinically as well as by serial measurements of coagulation factors and biochemical values. No significant difference was observed in the outcome among two groups, the recovery rate from the clotting defect being similar in both. The mean serum creatinine values of the two groups were also not statistically different. The results indicated that there is no beneficial effect of adding heparin to the standard treatment by antivenom.
Subject(s)
Disseminated Intravascular Coagulation/drug therapy , Heparin/administration & dosage , Snake Bites/drug therapy , Viper Venoms/adverse effects , Adult , Antivenins/administration & dosage , Disseminated Intravascular Coagulation/etiology , Dose-Response Relationship, Drug , Factor X/immunology , Female , Humans , Infusions, Intravenous , Injections, Intravenous , Male , Middle Aged , Snake Bites/bloodABSTRACT
The total yield of venom (desiccated) in 25 adult V. russelli (mean length 111 +/- 1.8 cm (S.E.) ranges from 21-268 mg (127 +/- 13 mg, mean +/- S.E.) and that of 13 juvenile snakes (mean length 79 +/- 2.8 cm) is 8-79 mg (45 +/- 7 mg). The venom yield per milking correlated well with the length of the snake. The average amount of venom injected in the first bite of 31 adults (mean length 107 +/- 1.4 cm) is 63 +/- 7 mg (range 6-147 mg) and by 17 juvenile snakes (mean length 83 +/- 1.1 cm) is 41 +/- 8 mg (range 3-138 mg). Adults inject 45% of the glands' content in the first bite. More than 75 mg of venom (desiccated) was injected by 11 out of 31 adults and 2 out of 17 juvenile snakes. This indicates that in a substantial proportion of cases of envenomation, 40 ml of Burma Pharmaceutical Industry monovalent antivenom, which is commonly used, may not be adequate.
Subject(s)
Snakes/metabolism , Viper Venoms/metabolism , Animals , Body Constitution , Female , Male , Snake Bites , Snakes/growth & developmentABSTRACT
Serum levels of venom antigen were measured using enzyme-linked immunosorbent assay (ELISA) in 38 Russel's viper bite victims before and after administration of 40 ml of monovalent liquid antivenom. Initial serum levels ranged from one with less than 10.0 ng to 290 ng/ml and in one case a level of 75 ng/ml was detected 27 hours after the bite. Serum venom levels after liquid monospecific antivenom therapy indicated that venom clearance was similar in each case to the natural clearance of venom in the absence of antivenom therapy. In one case a venom level of 11.5 ng/ml was detected 66 hours after liquid antivenom therapy whereas in two fatal cases, serum venom levels of 95 ng/ml and 185 ng/ml were detected after the same interval. Failure of complete neutralization of venom is probably the result of loss of potency of antivenom during improper storage. The amount of venom excreted in the urine was not related to initial serum levels.