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

Antivenoms     1293

Indications & dosages ➤ Treatment of systemic envenoming fromsea snakebite— Adults: 1000 U by slow IV infusion diluted 1 in 10 in Hartmann’s solution or normal saline, repeated if necessary. In severe envenoming, doses up to 10,000 units may be used. Children: 1000 Uby slow IV infusion diluted 1 in 5 in Hartmann’s solution or normal saline, repeated if necessary. Action Antivenom effective against venom Enhydrina schistosa and, to varying effect, other sea snakes present in northern Australian waters. Route Onset Peak Duration IV Unknown Unknown Unknown Adverse reactions CNS: headache. GI: abdominal pain, diarrhoea, 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 • Sea snake venom contains potent neuro­ toxins that cause muscle paralysis and respiratory failure, as well as myolytic prop­ erties causing myalgia, muscle weakness, trismus, ptosis, ophthalmoplegia, hyper­ kalaemia and renal failure in severe cases. • Myolysis causes elevation of serum glutamic oxaloacetic transaminase (SGOT), which can be used to determine or monitor the degree of envenoming.

• 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. • 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. • Anaphylactic reactions may be more likely in individuals who are atopic or have previously received equine serum. • Although considered controversial, indi­ viduals at risk of anaphylactic reactions may be givenpremedicationwith 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. stonefish antivenom Stonefish Antivenom Solution for Injection Pregnancy risk category NR Use in sport: Permitted Available form Solution for injection: 2000 U/vial