Template:Crofab dosing: Difference between revisions
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===Initial Administration=== | ===Initial Administration=== | ||
*Initial dose: 6 vials<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref> | |||
* | *Typically diluted into 250 cc or 1 L of normal saline and infused over an hour | ||
*Same dose for both adults and pediatrics (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded) | |||
===Maintenance therapy=== | ===Maintenance therapy=== | ||
*''Maintance therapy may be indicated after initial dosing based on local protocols even if control is achieved.<ref>Crofab treatment agorithmn http://www.crofab.com/documents/CroFab-Treatment_Algorithm.pdf</ref> | *May repeat dose (2 vials) at 6, 12, and 18 hours later if symptoms not controlled<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref> | ||
**''Maintance therapy may be indicated after initial dosing based on local protocols even if control is achieved.<ref>Crofab treatment agorithmn http://www.crofab.com/documents/CroFab-Treatment_Algorithm.pdf</ref> | |||
===Envenomation control measurement=== | ===Envenomation control measurement=== | ||
* | *Observe for progression of envenomation during and after antivenom infusion | ||
*Measure limb circumference at several | *Measure limb circumference at several sites above and below bite | ||
*Mark advancing border of edema q30min | *Mark advancing border of edema q30min | ||
*Repeat labs q4hr or after each course of antivenom (whichever is more frequent) | *Repeat labs q4hr or after each course of antivenom (whichever is more frequent) | ||
=== | |||
*Acute allergic reactions occur in <10% pts | ===Side Effects=== | ||
*Acute [[allergic reactions]] occur in <10% pts | |||
**If occurs stop infusion and give epinephrine/antihistamines if needed | **If occurs stop infusion and give epinephrine/antihistamines if needed | ||
*Recurrent [[thrombocytopenia]] has been described up to 2 weeks after transfusion with FabAV and is likely a result of isolated renal clearance of FabAV and persistent presence of actual venom in serum.<ref>Ruha AM et al. Late hematologic toxicity following treatment of rattlesnake envenomation with crotalidae polyvalent immune Fab antivenom. Toxicon. 2011;57:53–59.</ref> | *Recurrent [[thrombocytopenia]] has been described up to 2 weeks after transfusion with FabAV and is likely a result of isolated renal clearance of FabAV and persistent presence of actual venom in serum.<ref>Ruha AM et al. Late hematologic toxicity following treatment of rattlesnake envenomation with crotalidae polyvalent immune Fab antivenom. Toxicon. 2011;57:53–59.</ref> | ||
**Warrants close monitoring of platelets by primary physician or return visit after discharge | **Warrants close monitoring of platelets by primary physician or return visit after discharge | ||
*[[Serum sickness]] is unlikely but precautions should be given to patents upon discharge | *[[Serum sickness]] is unlikely but precautions should be given to patents upon discharge | ||
Latest revision as of 17:26, 28 September 2019
Initial Administration
- Initial dose: 6 vials[1]
- Typically diluted into 250 cc or 1 L of normal saline and infused over an hour
- Same dose for both adults and pediatrics (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)
Maintenance therapy
- May repeat dose (2 vials) at 6, 12, and 18 hours later if symptoms not controlled[2]
- Maintance therapy may be indicated after initial dosing based on local protocols even if control is achieved.[3]
Envenomation control measurement
- Observe for progression of envenomation during and after antivenom infusion
- Measure limb circumference at several sites above and below bite
- Mark advancing border of edema q30min
- Repeat labs q4hr or after each course of antivenom (whichever is more frequent)
Side Effects
- Acute allergic reactions occur in <10% pts
- If occurs stop infusion and give epinephrine/antihistamines if needed
- Recurrent thrombocytopenia has been described up to 2 weeks after transfusion with FabAV and is likely a result of isolated renal clearance of FabAV and persistent presence of actual venom in serum.[4]
- Warrants close monitoring of platelets by primary physician or return visit after discharge
- Serum sickness is unlikely but precautions should be given to patents upon discharge
- ↑ Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.
- ↑ Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.
- ↑ Crofab treatment agorithmn http://www.crofab.com/documents/CroFab-Treatment_Algorithm.pdf
- ↑ Ruha AM et al. Late hematologic toxicity following treatment of rattlesnake envenomation with crotalidae polyvalent immune Fab antivenom. Toxicon. 2011;57:53–59.