Biology Reference
In-Depth Information
Kirtland's twig snake or African vine or
bird snake,
Thelotornis kirtlandii
(and other
Thelotornis
spp.)
d
1
If indicated, give one ampoule of antivenom reconstituted with 10 mL
saline in 100 mL of Ringer's lactate or saline. Infuse over 30 min and
closely monitor for signs of anaphylaxis. Follow serial labs and provide
a second ampoule if the coagulopathy is not reversed.
Treat pediatric patients with the same dose as adults. Treat pregnant
women as indicated. In the USA, patients must be informed of the lack
of FDA approval of these products.
Anaphylaxis protocol should be immediately available prior to provision
of antivenom (see Section 4.6 for recommendations for managing
envenoming in the sensitized patient).
In delayed presentations of serious
D. typus
envenoming, antivenom can
be given up to 5-6 days following the bite. The delayed treatment of
R.
tigrinus
or
R. subminiatus
envenoming is less established, but is likely to
be similarly effective.
Tiger keel-back or yamakagashi,
Rhabdophis
tigrinus
1
Replace PRBCs as indicated; strive to maintain a low normal hematocrit
(remain aware of the potential for hemoglobinuric nephropathy; see
Section 4.6).
Role of FFP is controversial; it is unlikely to provide benefit.
There are no data to support use of heparin or antifibrinolytics (e.g.,
-aminocaproic acid) and these are contraindicated. The use of synthetic
protease inhibitor may be considered. It is unproven, but will likely not
exacerbate bleeding.
Coagulation and renal function must be closely serially monitored. Diuretics
have not been effective in re-establishing diuresis in cases featuring ARF.
Dialysis may be necessary but may not confer clinical improvement of renal
failure. In the event of ARF, nephrology consult is recommended.
(
Continued
)
