Sii Polyvalent
Anti-Snake Venom Serum

Snake Venom Anti-Sera (Lyophilised)

Directions for use
Sii Anti-Snake Venom Serum is a white or pale yellow lyophilised powder prepared by hyperimmunizing horses against the venoms of the corresponding poisonous snakes, namely:

  • Black Mamba (Dendroaspis polylepis)
  • Gaboon Viper (Bitis gabonica rhinoceros)
  • Russell's Viper (Vipera Russelli) and
  • Saw Scaled Viper (Echis Carinatus)

Plasma obtained 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 reconstituted Anti-Snake Venom Serum neutralizes not less than the following quantities of standard venoms when tested in white mice:

-             (MLD)
Black Mamba 0.45 mg (6 mcg)
Gaboon Viper 0.60 mg (24 mcg)
Russell's Viper 0.60 mg (10 mcg)
Saw scaled Viper 0.45 mg (15 mcg)

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:

  1. 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.

  2. 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.

  3. 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.

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 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 snakes listed.

Testing for allergy:
Dilute 0.1 ml of Anti-Snake Venom Serum with 0.9 ml of physiological saline solution.

Intracutaneous test:
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.

Conjunctival test:
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

  1. Draw 10 ml. of sterile water for injection in a sterile syringe.
  2. Transfer the sterile water from the syringe to the serum vial and shake well till the contents dissolve.
  3. 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.
  4. 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.

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.

One dose vial of lyophilised Sii Polyvalent Anti-Snake Venom Serum with 10 ml ampoule of sterile water for injections.

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