Directions for use
Anti-Snake Venom Serum is prepared by hyperimmunizing horses
against the venoms of the four common poisonous snakes of
- Cobra (Naja-Naja)
- Common Krait
Viper (Vipera russelli) and
Viper (Echis carinatus)
from the hyperimmunized horses is enzyme refined, purified and
concentrated. Each vial when reconstituted to 10 ml with
sterile water for injections, each 1 ml of the Anti-Snake
Venom Serum neutralizes not less than the following quantities
of standard venoms when tested in white mice:
Treatment of Snake-Bite
I. First Aid
Snake-bite should be treated immediately. The measures to meet
the emergency should be quick and positive. The following
first-aid measures have definitely proved their value:
Remove the patient to a well-ventilated and
quiet place. Assure the patient that there is no reason to be
nervous or frightened. Try to gain his confidence. Institute
measures to combat shock which has a major psychological
element in it.
Ligation: A ligature of some type should be
bound at moderate distance above the bitten part, to prevent
the venom being absorbed into the upper part of the limb. The
ligature may consist of a strip of cloth a large handkerchief,
or even a piece of heavy cord.
A rubber ligature is by far the best. It is necessary to make
the ligature sufficiently tight to cause a stoppage of venom
circulation. Ligation should not continue for over half an
hour and even then should always be slackened at regular
intervals of ten minutes during this time. Ligature should not
be applied if an hour or more has elapsed after the bite.
Treat the wound in the usual surgical way.
Clean the bitten part and apply antiseptic dressings without
rubbing. Immobilize the bitten part as in fracture cases.
II Specific Serum Treatment
Once the venom has got into the circulation, it is only the
Anti-Snake Venom Serum that can neutralise it.
In order to derive the greatest benefit out of serum
treatment, the serum should be injected as soon as possible,
after the bite. As a first dose, at least 20 ml of the
reconstituted serum (see below) should be injected
intravenously very slowly (not over 1 ml per minute). The
second dose should be repeated two hours after the first dose
or even earlier, if symptoms persist. If the symptoms, which
vary with different venoms, indicate persistence of venom
action, further doses should be repeated every six hours until
the symptoms completely disappear. In case of a viper bite
some serum should also be injected around the site of the bite
to prevent gangrene which otherwise results owing to the very
destructive effect of localized viper venom on tissue.
In case of Russell's and Saw-Scaled viper poisonings the local
symptoms are prominent and severe. There is great and
persistent pain and intensive swelling at the site of the
bite. There is constant and incessant oozing of blood from the
punctures. Sloughing occurs permitting other infections. The
constitutional symptoms are characterised by haemorrhages,
both external and internal, Haemorrhages in the abdomen are
responsible for pain, tenderness and vomitting. Death is due
to heart failure; there is no paralysis.
The venoms of Cobra and Krait act very rapidly if a large
amount of venom is absorbed into the circulation. Hence, it
must be understood, that unless the absorption of the venom
into the circulation is retarded by ligation, the anti-snake
venom serum does not get a fair chance to neutralize the
venom, and save the victim.
First aid treatment should, never be relaxed even when the
serum is administered.
Intravenous injection of a serum in horse-serum-sensitive
subjects can produce very severe serum reaction and even acute
anaphylaxis. Every care should be taken to prevent these
reactions (see below), Intramuscular or subcutaneous
injections of the anti-snake venom serum are not as effective
as intravenous injections. But if expert medical aid is not
available, the serum may be administered by the subcutaneous
or the intramuscular route.
Intravenous injections should always be, given very slowly. It
is of great advantage to dilute the serum 5 to 10 times with
normal or glucose saline and to administer it very slowly, if
possible, as a slow drip.
III Associated Treatment
In case of Russell's and Saw-scaled viper poisoning,
sedatives, such as small doses of barbiturate and /or
analgesics (e.g.aspirin) may be given to relieve nervousness
and pain. For collapse, strychnine, pituitrin or other general
stimulants like coramine are of special value. The use of
corticosteroids helps to minimise serum reaction and minor
allergic reactions. Antibiotics may also be given to combat
local sepsis. In all severely poisoned persons, great relief
is likely to be experienced from the infusion of a large
amount of physiological saline, or still better, transfusion
of blood or plasma, the effect of which may be life saving in
border-line cases. Respiratory paralysis should be treated by
tracheostomy and artificial respiration.
Antitoxic therapy in the case of bites from the venomous
Testing for allergy:
Dilute 0.1 ml of Anti-Snake Venom Serum with 0.9 ml of
physiological saline solution.
Apply 0.1 ml of this 1:10 dilution intracutaneously on the
inside of the forearm. If a wheal with erythema develops at
the site of injection within the next 15 minutes, the patient
is hypersensitive to equine protein.
If the anamnesis gives rise to suspicion of an allergy to
equine protein, 0.05 ml of the anti snake venom serum diluted
1:1000 should be given as a precautionary measure.
Introduce 1 drop of the 1:10 dilution of anti-snake venom
serum into the conjunctival sac. If itching, conjunctival
reddening, lacrimation and / or edema of the lid appear within
the next 15 minutes, the test is positive.
Both tests should be controlled by applying the same dose of
physiological saline solution to the other arm or eye
respectively, using the same technique.
Prevention of Serum Reaction:
Before administering injection of Anti-Snake Venom Serum, it
is necessary to enquire from the patient.
1. Whether he has had injections of serum (e.g. anti-tetanus
or anti-diphtheria serum before).
2. Whether there is personal or familial history of allergy
i.e. asthma, eczema or drug allergy.
The sensitivity of the patient to Anti-Snake Venom Serum is
tested by injecting subcutaneously 0.1 ml of the serum diluted
1:10. The patient should be observed for 30 minutes for local
and general reactions. If the test dose shows either local
reaction such as flare or general anaphylactic reaction such
as pallor sweating, nausea. vomiting, urticaria and fall of
blood pressure these should be countered immediately by
intramuscular injection of 1ml of 1:1000 adrenaline and with
corticosteroids which should be always kept handy.
In allergic or sensitive patients it is better to inject the
Anti-Snake Venom Serum under cover of anti-histaminics such as
antistine (100 mg) and hydrocortisone (100 mg) intramuscular
15 to 30 minutes before the administration of Anti-Snake Venom
Serum. The administration of adrenaline and hydrocortisone may
be repeated if necessary.
When symptoms of snake-bite are severe it may not be advisable
to wait for 30 minutes to observe reactions to test-dose of
serum. In such cases it may be better to inject 1 ml of 1:1000
adrenaline intramuscular at the same time as the serum in
order to lessen the risk of anaphylaxis. Half the dose of
adrenaline may be repeated 15 minutes later if necessary.
Reconstitution of Lyophilised Serum
- Draw 10 ml. of sterile water for injection in a sterile
- Transfer the sterile water from the syringe to the serum
vial and shake well till the contents dissolve.
- Let the vial stand for one minute for the serum to
clear. The reconstituted serum will become crystal-clear and
ready for injection. Froth and undissolved particles if any
should be left in the vial.
- For the second and subsequent injection you will have
more time to dissolve the lyophilised serum. For these add
10 ml sterile water for Injections to the serum vial and
rotate in between the palms of your hands until the serum is
full dissolved and let the vial stand for serum to clear.
serum is very unstable at room temperature. It requires
storage at 0°C to 4°C. Even then it deteriorates, and 2 years
from the date of manufacture, the serum becomes unfit for use.
In India, proper cold-storage facilities are not freely
available and, therefore, liquid serum may only be stored at
the risk of very rapid deterioration. Lyophilised serum
obviates this difficulty. It is many times more stable than
liquid serum. It should retain its potency for 5 years even if
stored in any cool dark place. Thus Anti Snake Venom can be
made available for use far away from cold storage facilities.
It can be safely kept at rural dispensaries and even carried
in a haversack if an occasion demands it. However, it is
preferable to store it in a refrigerator if one is available. STORE IN A COOL DARK PLACE.
One dose vial of lyophilised Sii Polyvalent Anti-Snake
Venom Serum with 10 ml ampoule of sterile water for
Instructions for use
1) Hold the flat
diluent ampoule top
2) Twist flat ampoule top in clockwise direction.
3) Separate flat ampoule top to expose 'LUER LOCK'
Reconstitution of lyophilised vials
1) Draw the diluent from the ampoule in to a
syringe, pierce the bung of the vial with the needle and
gently inject the diluent into the vial.
2) Detach the syringe,
leaving the needle in vial bung. After 15 seconds remove the
3) Rotate the vial gently between your palms
till the material dissolves.
Avoid shaking the vial as this would cause frothing.
4) Withdraw the re-constituted solution
into the syringe, now ready for administration.