McKenna's Drug Handbook for Nursing & Midwifery, 7e

Antivenoms     1295

Adults and children: 12,000 U by slow IV infusion diluted 1 in 10 in Hartmann’s solution or normal saline, repeated if necessary. Individuals with severe systemic envenoming may require up to 8 vials. Action Antivenomeffectiveagainstvenomoftaipan snake ( Oxyuranus scutellatus , Oxyuranus microlepidotus , Oxyuranus scutellatus canni) . Route Onset Peak Duration IV Unknown Unknown Unknown Adverse reactions CNS: headache. GI: abdominal pain, nausea, vomiting. Skin: injection site reaction, urticaria, rash. Musculoskeletal: chest pain, myalgia. Other: allergic reactions, anaphylaxis , delayed serum sickness , chills, pyrexia. Interactions None reported. Contraindications Should not be used unless there is evidence of systemic envenoming with potential for serious toxic effects. care considerations • Taipan venom contains neurotoxin that causes respiratory paralysis, myolytic toxin and coagulant, which converts prothrombin to thrombin, which in turn produces a secondary afibrinogenaemia with resultant haemorrhage. Myolytic toxin causes myalgia, muscle weakness, trismus, ptosis, ophthalmoplegia, hyperkalaemia and renal failure in severe cases. • Monitor vital signs, neurological and mental status and evidence of respiratory depression. • Monitor FBC, platelets, INR and aPTT on presentation, immobilisation (if used) and 6 hours thereafter. • Monitor for signs and symptoms of bleeding (bruising, bleeding fromgums and venepuncturesites,epistaxis,gastrointestinal

bleeding, haematuria, altered mental status suggesting intracranial haemorrhage). • Monitor renal function, urine output, serum electrolytes and urinalysis. • As product is sourced from horse plasma, potential for transmission of infectious disease cannot be ruled out. • Anaphylactic reactions may be more likely in individuals who are atopic, have previously received equine serum or are receiving antivenom by IV route. • Although considered controversial, individuals at risk of anaphylactic reactions may be given premedication with adrenaline and antihistamine. • Have adrenaline 1:1000 available in case of anaphylactic reaction. • Severe cases should be managed in intensive care unit. • Monitor for delayed serum sickness within 8–13 days after the administration of antivenom, manifestedby albuminaemia, arthralgia, fever, lymphadenopathy and skin eruptions. • Monitor the person closely for at least 6 hours after administering antivenom. Patient teaching • Advise person of risk of possible infectious disease transmission as venom is sourced from horse serum. • Instruct person to report any adverse effects—such as shortness of breath, itching, skin swelling, fever or chest pain— immediately. tiger snake antivenom Tiger Snake Antivenom Concentrate for Infusion Pregnancy risk category NR Use in sport: Permitted Available form Solution for injection: 3 000 U/vial