Australian and Pacific Snakes

Risks and realities of single vial antivenom recommendations for envenoming by Australian elapid snakes

“…Moreover, direct clinical concerns about the single vial recommendation emphasise the need in some patients for significantly larger doses of antivenom . In Australia, snakebite victims manifest severe envenoming in perhaps 15% of cases .…”

“…For example, some insular tiger snake ( Notechis scutatus ) populations (eg, on Chappell Island and Kangaroo Island) and some mainland specimens can produce venom volumes far greater than average reported yields. This was recognised by the antivenom manufacturer that recommended initial multiple vial antivenom doses for serious envenoming by snakes from insular populations . Even some envenoming by Australian elapid species (eg, red‐bellied black snake [ Pseudechis porphyriacus ]) that most authorities accept can be treated with a single vial of antivenom may sometimes require greater amounts of antivenom in order to effectively treat the seriously envenomed patient …”