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

1288      Miscellaneous drug categories

Action Antivenom against toxin of box jellyfish ( Chironex fleckeri) found in Australian tropical waters. Route Onset Peak Duration IV Unknown Unknown Unknown Adverse reactions Skin: urticaria, rash. Other: allergic reactions, anaphylaxis , delayed serum sickness . Interactions None reported. Contraindications Should not be used unless there is evidence of systemic envenoming or extensive local involvement with intractable pain. care considerations • Box jellyfish venom contains toxins that affect the myocardium and neuromuscular functioning of the respiratory system and cause dermatonecrosis. In severe cases, death can occur in as little as 20 minutes. • Antivenom should be administered as soon as possible after cardiopulmonary resuscitation has commenced. • Not all individuals stung by box jellyfish will require antivenom. • As product is sourced from ovine plasma, potential for transmission of infectious disease cannot be ruled out. • Not administered by IM injection. • Venom detection kits should be used to detect and identify specific venom at the bite site or in urine where possible. • 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.

• 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. • Althougheffectiveagainstother Pseudechis genus members, tiger snake antivenom is usually the preferred treatment. • 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. • Instructpersontoreportanyadverseeffects —such as shortness of breath, itching, skin swelling, fever or chest pain—immediately. box jellyfish antivenom Box Jellyfish Antivenom Solution for Injection Pregnancy risk category NR Use in sport: Permitted Available form Solution for injection: 20,000 U/vial Indications & dosages ➤ Treatmentofboxjellyfishstingdemonstrating systemic envenoming or extensive local involvement— Adults: 20,000 U by slow IV infusion diluted 1 in 10 with Hartmann’s solution, repeated if necessary. Children: 20,000 U by slow IV infusion diluted 1 in 5 with Hartmann’s solution, repeated if necessary.

Reactions may be common , uncommon, life-threatening , or commonandlife-threatening.