Tiger Snake Antivenom
Liverpool Hospital Emergency Department
Indications:
- Tiger Snake Envenoming
- Unidentified snake envenoming and no requirement for polyvalent antivenom given in combination with brown snake antivenom
Formulation: Stock 1
- 3000 units of Tiger antivenom each vial
Dosage and Administration
- Tiger Snake Envenoming or DEFINITE RED BELLIED BLACK SNAKE BITE (indicated if there is expert identification or the snake, discussion with a clinical toxicologist or poisons information centre, or geographic indication (e.g. Tasmania))
- 1 vial tiger snake antivenom diluted 1:10 0.9% NaCl or Hartmanns IV over 15 minutes. If at risk of fluid overload or paediatric case dilute in a 1:5 ratio
- Unidentified snake envenoming
- 1 vial brown snake antivenom & 1 vial tiger snake antivenom diluted 1:10 in NaCl 0.9% or Hartmanns. Give IV over 15-20 minutes
- In children or those with risk of fluid overload dilute 1:5.
- In life-threatening emergency situations antivenom can be given undiluted as a rapid injection.
- Administer in a critical care area with readily available adrenaline and resuscitation equipment
Side Effects
- Immune mediated hypersensitivity reactions occur in 25% of cases with urticaria / rash
- Anaphylaxis occurs in 2-3% of patients and manifests as hypotension
- If there is an acute allergic or anaphylactic reaction temporarily stop the infusion and treat accordingly then recommence the infusion at a slower rate.
- IgE mediated reactions occur generally in snake handlers who have had prior venom exposure and anaphylaxis to venom ****DO NOT WITHHOLD ANTIVENOM IN THESE PATIENT***
- Treat hypersensitivity by ceasing the antivenom temporarily
- Administer IM adrenaline if severe (adult 500mcg 1:1000 IM / paediatric 10microgram/kg IM)
- Delayed serum sickness;
- fever, rash, arthralgia and myalgia:
- Moderate to severe serum sickness can be treated with prednisolone
- There is no role for premedication in Australian snake bites
Pit Falls:
- DO NOT WITHHOLD ANTIVENOM in cases of snake handlers who have venom associated anaphylaxis
- One vial of each of tiger snake and brown snake monovalent antivenom covers most unidentified snake bites in SWSLHD including red bellied black snake envenoming
- Recovery can be difficult to assess and is based on reversibility of the venom effects and time for the body to recover post venom neutralisation
- Systemic effects such as VICC are irreversible and venom only prevents this if given early – will take 24-36 hours to resolve
- Clotting times will only normalise after a few days
- Discuss major bleeding with clinical toxicologist re role of clotting factor replacement and surgical intervention
- Discharge after resolution of symptoms / no evidence of thrombotic microangiopathy and kidney injury / normal INR / decreasing CK
- All antivenom can be given in pregnancy
- Warn re serum sickness when discharging