Management of Thai cobra bites with a single bolus of antivenin

Abstract

Between January 1981 and December 1991, 68 adults were treated at Chulalongkorn University for cobra bites. Respiratory failure developed in the bite victims even when an adequate genus-specific antivenin was administered at the onset of neuromuscular paralysis. The duration of time spent on a respirator was, however, significantly less in patients treated with an intravenous 100-ml antivenin bolus given at the onset of neurotoxic signs. We found that a bolus of 100 ml of purified equine antivenin produced by the Queen Saovabha Memorial Institute, Bangkok, from Naja kauthia venom was adequate and that increasing the dose did not lead to added benefits. Time spent on a respirator was approximately 10 h in antivenin-treated groups and 40 h if no antivenin or an inadequate dose was used. Competent respiratory and nursing care alone without antivenin will lead to eventual recovery and prevent death. Local bite site tissue necrosis and duration of hospitalization were not related to the dose of antivenin given. Hospitalization was prolonged in subjects who developed sepsis or who had severe tissue necrosis or other surgical or medical complications.

Antivenom for Neuromuscular Paralysis Resulting From Snake Envenoming

“…A study of Thai cobra ( Naja kaouthia and/or N. sumatrana ) envenoming compared a group of patients who did not receive antivenom (historical) with three groups of patients who received a bolus of Thai cobra antivenom [85]. The antivenom-treated patient group had three sub-groups, each sub-group receiving a different antivenom dose (i.e., 50, 100 and 200 mL).…”

Influential Factors of Local Tissue Necrosis after Taiwan Cobra Bites: A Secondary Analysis of the Clinical Significance of Venom Detection in Patients of Cobra Snakebites

“…A cobra bite is a critical issue as snakebites envenomation is considered a neglected tropical disease [ 1 ]. Envenomation caused by different Naja species such as Naja siamensis (Thai spitting cobra) [ 4 ], Naja kaouthia (monocellate cobra) [ 2 , 20 ], Naja naja (Indian cobra) [ 3 , 21 ], and Naja mossambica (Mozambique spitting cobra) [ 5 , 7 ] share the common features of local tissue swelling, inflammation, infection, and significant tissue necrosis as does Taiwan cobra bites [ 11 , 14 ]. Our study has substantial potential for improving treatment strategies for cobra-bite-associated wound necrosis.…”

“…Cobra bites are a critical issue given that snakebite envenomation is considered a neglected tropical disease [ 1 ]. Except for systemic neurotoxicity, different degrees of muscle weakness, paralysis, significant local tissue swelling, inflammation, and wound necrosis follow most cobra snakebites [ 2 , 3 , 4 , 5 , 6 , 7 ]. As one of the six medically important venomous snake species found in Taiwan, Taiwan cobra ( Naja atra ) envenomation accounts for approximately 20% of snakebite cases but with almost no mortalities [ 8 ].…”

Dose of antivenom for the treatment of snakebite with neurotoxic envenoming: Evidence from a randomised controlled trial in Nepal

“…Most published studies lacked a proper power calculation [7,10,34], were un-blinded [7,9,10] and/or used inappropriate or incomplete randomization [10,12,34]. Moreover, several studies mixed neurotoxic and haematotoxic envenoming or included patients with nonspecific manifestations like confusion or bradycardia [7–9].…”