Australian Snakebite and Treatment

Rough‐scaled snake envenomation

“…1 Although the neurotoxins or myotoxins in RSS have not been specifically identified, 'notexin' in tiger snake venom is the predominant neurotoxin but also has rhabdomyolytic properties. 3 In a series of 24 cases of RSS envenomation, all patients had VICC, with 19 patients having an INR > 3.0. 1 Recovery of their INR to a value <2.0 took a median time of 11.5 h. Although in our case the INR on presentation was 1.8, it was likely significantly higher during the preceding 24 h based on the natural course of VICC reported in 112 patients and the Ddimer > 20 mg/L at 24 h. 4 In the RSS case series, two patients developed symptoms of neurotoxicity and one patient had biochemical signs of myotoxicity but no patient required any form of organ support.…”

Risks and realities of single vial antivenom recommendations for envenoming by Australian elapid snakes

“…Moreover, direct clinical concerns about the single vial recommendation emphasise the need in some patients for significantly larger doses of antivenom . In Australia, snakebite victims manifest severe envenoming in perhaps 15% of cases .…”

“…The assessment of the first case by clinical toxinologists found that two vials as an initial dose was definitely justified . It is arguable whether additional antivenom would have had therapeutic benefit for this patient, but providing it earlier is highly desirable because this could conceivably neutralise sequestered venom as it is absorbed from the bite site and may therefore bind circulating venom toxins as they enter the vascular system . However, a single vial of antivenom would clearly be insufficient for patients with envenoming similar to these examples.…”