A1,
A2,
B,
C1,
C2,
D,
E,
F,
G-H,
I-K,
L,
M,
N,
O,
P1,
P2,
Q-R,
S,
T,
U-V,
W-Z
Rattlesnake Antivenin Warnings, Precautions, Pregnancy, Nursing, Abuse - Antivenin (Crotalidae) Polyvalent
Rattlesnake Antivenin Warnings, Precautions, Pregnancy, Nursing, Abuse - Antivenin (Crotalidae) Polyvalent
WARNINGS
No information provided.
PRECAUTIONS
Before administration
of any product prepared
from horse serum, appropriate measures must be taken in an effort
to detect the presence of dangerous sensitivity: (1) A careful review
of the patient’s history, including any report of (a) asthma, hay
fever, urticaria, or other allergic
manifestations; (b) allergic
reactions upon exposure
to horses; and (c) prior injections of horse serum. (2) A suitable
test for detection of sensitivity.
A skin test should be performed in every patient
prior to administration, regardless of clinical
history.
Skin test—Inject intracutaneously 0.02 to 0.03 mL of a 1:10
dilution of Normal Horse Serum or Antivenin. A control
test on the opposite extremity,
using Sodium Chloride Injection, USP, facilitates interpretation.
Use of larger amounts for the skin-test dose
increases the likelihood of false-positive reactions, and in the
exquisitely sensitive
patient, increases the risk of a systemic
reaction from the skin-test
dose. A 1:100 or greater dilution should be used for preliminary
skin testing if the history
suggests sensitivity.
A positive reaction
to a skin test
occurs within five to thirty minutes and is manifested by a wheal
with or without pseudopodia and surrounding erythema. In
general, the shorter the interval
between injection
and the beginning of the skin
reaction, the greater the sensitivity. If the history is negative
for allergy and the result of a skin
test is negative, proceed
with administration
of Antivenin as outlined above. If the history is positive and a
skin test
is strongly positive, administration
may be dangerous, especially if the positive
sensitivity test is accompanied
by systemic allergic manifestations. In
such instances, the risk
of administering Antivenin must be weighed against the risk
of withholding it, keeping in mind
that severe envenomation
can be fatal. (See last paragraph of this section.) A negative
allergic history and
absence of reaction
to a properly applied skin test
do not rule out the possibility
of an immediate reaction.
Also, a negative skin
test has no bearing on
whether or not delayed serum
reactions (serum sickness) will
occur after administration
of the full dose.
If the history is negative, and the skin
test is mildly or questionably
positive, administer as follows to reduce
the risk of a severe immediate
systemic reaction: (a) Prepare, in separate sterile
vials or syringes, 1:100 and 1:10 dilutions of Antivenin. (b) Allow
at least 15 minutes between injections and proceed with the next
dose if no reaction
follows the previous dose. (c) Inject subcutaneously, using a tuberculin-type
syringe, 0.1 , 0.2, and 0.5 mL ofthe 1:100 dilution
at 1 5-minute intervals; repeat with the 1:10 dilution, and finally
undiluted Antivenin. (d) If a systemic
reaction occurs after any injection, place a tourniquet
proximal to the site
of injections and administer an appropriate
dose of epinephrine, 1
:1 000, proximal to the tourniquet
or into another extremity. Wait at least 30 minutes before injecting
another dose. The amount of the next dose
should be the same as the last that did not evoke a reaction. (e)
If no reaction occurs after 0.5 mL of undiluted Antivenin has been
administered, switch to the intramuscular
route and continue doubling the dose
at 1 5-minute intervals until the entire
dose has been injected
intramuscularly or proceed to the intravenous
route as described above under “Dosage and Administration.”
Obviously, if the just-described schedule
is used, 3 to 5 or more hours would be required to administer the
initial dose
suggested for a moderate or severe envenomation, and time
is an important factor
in neutralization of venom
in a critically ill patient.
Wingert and Wainschel 4 have described a procedure
based on the experience
of their group which they
have used in some severely envenomated patients who have positive
sensitivity tests: 50 to 100 mg
of diphenhydramine hydrochloride
is given intravenously, followed by
intravenous infusion
of diluted Antivenin for 15 to 20 minutes while carefully observing
the patient for symptoms
and signs of anaphylaxis; if anaphylaxis
does not occur, Antivenin is continued, maintaining close observation
of the patient. Patients who require Antivenin but develop signs
of impending anaphylaxis
in spite of this or the procedure
described earlier present
a difficult problem, and consultation
should be sought.
Systemic REACTIONS
A. The immediate
reaction (shock, anaphylaxis)
usually occurs within 30 minutes. Symptoms and signs may develop
before the needle is
withdrawn and may include apprehension, flushing, itching, urticaria;
edema of the face, tongue,
and throat; cough, dyspnea, cyanosis, vomiting, and collapse.
B. Serum sickness
usually occurs 5 to 24 days after administration. The incubation
period may be less than
5 days, especially in those who have received horse-serum-containing
preparations in the past. The usual symptoms and signs are malaise,
fever, urticaria, lymphadenopathy, edema, arthralgia, nausea, and
vomiting. Occasionally, neurological manifestations develop, such
as meningismus or
peripheral neuritis.
Peripheral neuritis usually involves the shoulders and arms. Pain
and muscle weakness
are frequently present, and permanent
atrophy may develop.
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