Emergency Medicine Book

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Snake AntiveninAka: Antivenin Crotalidae Polyvalent, CroFab

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  1. Indications: Venomous Snake Bite
    1. Unstable SnakeBite patient
    2. All eastern Coral Snake bites
    3. Clinical worsening in SnakeBite patient
      1. Progressive local swelling and Ecchymosis at bite
      2. Coagulopathy
      3. Hypotension
      4. Mental status changes
  2. Efficacy: Effective if given within 24 hours of bite
    1. Most beneficial if given within 4 hours of bite
  3. Contraindications
    1. Positive Skin Test for Horse Serum Sensitivity
    2. Mild pit viper bite
  4. Preparations
    1. Pit vipers (Rattlesnake, Cottonmouth, Copperhead)
      1. Equine-derived Snake Antivenin (horse derived)
        1. Antivenin Crotalidae Polyvalent (ACP)
      2. Ovine-derived Snake Antivenin (CroFab)
    2. Eastern Coral Snake antivenin (Micrurus fulvius)
      1. Required in all Coral Snake bite cases
  5. Protocol
    1. Start reconstituting antivenin on patients ER arrival
      1. Requires 60 minutes to prepare
    2. Consider Skin Test for Horse Serum Sensitivity
      1. Controversial due to lack of efficacy
      2. Only advantage may be a medicolegal one
    3. Consider Premedication for Allergy Prevention
    4. Be prepared for Anaphylaxis
    5. Administer antivenin
      1. Depending on severity may require more than 25 vials
      2. Protocols vary for ACP, CroFab, and Coral antivenin
      3. Antivenin doses are the same for children and adults
  6. Adverse effects
    1. Serum Sickness
    2. Severe allergy or Anaphylaxis
      1. ACP: 23 to 56% Allergic Reaction rate
      2. CroFab: 14.3% Allergic Reaction and none severe
  7. Resources (Antivenin sources)
    1. Arizona Poison and Drug Information Center
      1. Exotic snake antivenins
      2. Phone: 520-626-6016
    2. American Zoo and Aquarium Association
      1. Antivenin indexes
      2. Phone: 301-562-0777
  8. References
    1. Dart (2001) Ann Emerg Med 37:181
    2. Juckett (2002) Am Fam Physician 65(7):1367
    3. McKinney (2001) Ann Emerg Med 37(2):168

Polyvalent crotalidae antivenin (C0305048)

ConceptsAmino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) , Immunologic Factor (T129)
EnglishNorth and South American antisnake serum, Polyvalent crotalidae antivenin, Polyvalent crotaline antivenin
Spanishantiveneno polivalente crotalidae, suero anticrotálido polivalente, suero anticrotalido polivalente, suero antiofídico de América del Norte y América del Sur, suero antiofidico de America del Norte y America del Sur
CreditsDerived from the NIH UMLS (Unified Medical Language System)


CroFab (C1145755)

ConceptsAmino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) , Immunologic Factor (T129)
EnglishCroFab
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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