Evaluation of antivenom therapy in Vipera palaestinae bites

Vipera Palaestinae Bite and Serum Sickness During Pregnancy

“…The venom contains mainly enzymatic polypeptides, including hemorrhagins, proteases, phospholipase A 2 , hyaluronidase, esterases, phosphodiesterases, and L-amino acid oxidases (1). The clinical manifestations reflect the action of these enzymes; endothelial damage increased capillary permeability, platelet abnormalities, thromboplastin and thrombin inhibition, release of histamine and kinins, and possible, although not proven in humans, depression of medullary autonomic vasoregulation (1). The clinical manifestations are both local and systemic.…”

“…The clinical manifestations are both local and systemic. The systemic signs include abdominal pain, vomiting, nausea, diarrhea, tachycardia, hypotension, thrombocytopenia, and infrequently, anaphylactoid reaction (1,4,5). In the era before specific antivenom was available, mortality rate was 5%, and has decreased to 0.65% thereafter (2).…”

“…The mean amount of venom in one envenomation is 2000 mouse LD 50 . The indications for antivenom treatment are the presence of systemic signs or marked progressive local signs (1,5). The standard dose is 50 mL (five 10-mL ampules) administered over 2 h; 5.6% of the patients require two to three additional 30 -50 mL doses due to progressive local manifestations (1).…”

“…This mode of antivenom administration is not widely accepted in Israel. These two series did not include pregnant women (1,4).…”

“…infusion preceded by i.v. 1 mL test dose over 10 min, according to previously published protocol (1,2). During the following hours, the pain and swelling receded; her blood pressure rose to 101/65 mm Hg, and she had no gastrointestinal manifestations.…”