Polyvalent Anti-Snake Venom Serum (central Africa) is prepared
from hyperimmunised equines against the venoms of the corresponding
poisonous snakes, namely:
- Black Mamba
- Gaboon Viper (Bitis gabonica
Viper (Vipera Russelli) and
- Saw Scaled
Viper (Echis Carinatus)
from the hyperimmunised equines is enzyme refined, purified
and concentrated. Each ml. of the reconstituted Anti Snake
Venom Serum neutralises not less than the following quantities
of standard venoms when tested in white mice.
Snake venom envenomation is serious and could be life threatening.
The effects produced by the action of snake venoms vary considerably
according to the group to which the particular venom belongs.
This in turn depends upon the composition of the venom.
In principle, the effects produced fall into 2 categories.
1. One causing damage to the nervous system (Neurotoxic),
predominating mainly in the elapids, e.g. Black Mamba.
2. One breaking down tissues and destroying the red blood
cells (Cytotoxic), induced mainly by the
venom of viperid and crotalid snakes. e.g. Gaboon
viper, Russell's viper and saw scaled viper.
However, this must not be taken as an inflexible rule.
In case of Black Mamba poisoning, the venom
being a protein of low molecular weight, is able to spread
extraordinarily rapidly within the bitten tissue. The constitutional
symptoms are more prominent than local pain and swelling.
General intoxication is soon followed by a sense of creeping
paralysis beginning in the legs and ascending to the head
by way of trunk. Paralysis of the muscles of the eyelids,
staggering gait, incoordination of speech, paralysis of the
limbs, drooping of the head and complete paralysis of all
the voluntary muscles develop. Nausea and vomiting frequently
occur. Breathing gets more and more difficult and finally
stops. The death of a victim is usually brought about as a
result of respiratory failure or the suspension of cardiac
Because of its proteinaceous nature,snake venom is able to
take effect only when it enters into the lymphatic or blood
system or into the body tissue. If taken into the alimentary
canal, it is destroyed by the digestive enzymes. Therefore,
when large amount is absorbed into circulation, the venom
acts very rapidly. 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 neutralise the venom and save the victim.
In cases of viper poisoning (Gaboon viper, Russell's
viper and Saw Scaled viper) the venom is characterised
by a low content of neurotoxins; but large quantities of cytotoxins
and these being proteins of high molecular weight, diffuse
slowly within the tissues and so they produce at first, severe
symptoms of poisoning in the region of the bite. Therefore,
local symptoms are prominent and severe. There is great and
persistent pain and intensive swelling at the site of bite.
The venom of the viper contains several enzymes which may
be possibly act synergistically to produce shock, spontaneous
haemorrhages in the organs and tissues, acute necrosis and
death. There is constant and incessant oozing of blood from
the punctures. Sloughing occurs permitting other infections.
The venom has a toxic effect on may different types of cells
causing destruction of cell membranes. The constitutional
symptoms are therefore characterised by haemorrhages both
external and internal. Haemorrhages in the abdomen are responsible
for pain, tenderness and vomiting. Death is due to heart failure,
there is no paralysis.
TREATMENT OF SNAKE BITE
Keep the patient calm
let the patient lie down to ensure that the bitten part
is at rest with minimal activity in a well ventilated
Clean the bitten part
by washing with care without disfiguring or defacing
bite mark. Apply a broad and firm antiseptic dressing/bandage.
SPECIFIC SERUM TREATMENT
1. Immediate neutralisation of the circulating venom is of
2. For fast effect, the Anti Snkae Venom Serum should be injected
intravenously as soon as possible after the bite. As a first
dose, at least 20 ml. of the reconstituted serum should be
injected intravenously very gradually (for every 1 ml per
3. The second dose should be repeated two hours after the
first dose or even earlier. If the symptoms persist. If the
symptoms, which vary with different snake venoms, indicate
persistence of venom action, further doses should be repeated
aftr every six hours until the symptoms disappear completely.
4. At present, there is no simple method to measure the amount
of circulating venom in the body, therefore the antivenin
dose cannot be accurately recommended. It has been found that
the clotting time returns to normal about two hours after
the neutralisation of venom therefore repeated testing of
clotting time after the antivenom therapy is necessary. Close
monitoring of the patient's condition with urine output, BP,pulse,
respiration and urea and electrolyte estimations must be done.
Local pain and necrosis at the site of bite may need attention,
but is usually not very serious except in special circumstances
such as a bite on the digit which can become gangrenous.
5. In case of Viper bite, some of the Anti Snake Venom Serum
should also be injected around the site of the snake bite
additionally to prevent gangrene which is one of the more
distructive effects of localised Viper Venom on tissue.
6. First Aid treatment should never be relaxed even when the
serum is administered. Intravenous injection of a reconstituted
Anti Snake Venom Serum in equine serum sensitive subjects
can produce very severe serum reactions and even acute anaphylaxis.
Further care should be taken to prevent these reactions.
7. Intravenous injection is the most effective but if expert
medical aid is not available the serum may be administered
by a subcutaneous or through intramuscular route. It is more
efficacious to dilute the serum 5-10 times with normal or
glucose saline and be administered as slowly as possible,
if possible as slow as a drip.
1. In case of Gaboon, Russell's and Saw-scaled viper envenomation,
sedatives such as small doses of barbiturate and/or analgesics
(e.g. aspirin) may be given to relieve nervousness and pain.
2. In case of syncope / shock, strychnine, pituitrin or other
general stimulants like coramine may be used. The use of corticosteroids
would help minimise serum reaction and other minor allergic
3. Treatment of antibiotics may also be given to combat local
sepsis in severely envenomated cases, infusion of a large
amount of physiological saline or transfusion of blood or
plasma may not only bring substantial releif but may be life
saving in borderline cases.
4. Cases of respiratory paralysis should be treated by tracheostomy
and artificial respiration.
5. Anti Tetanus injection may be given.
DIRECTIONS FOR USE
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 injections, you will have
more time to dissolve the lyophilised serum. For these
add 10 ml sterile water for injection to the serum
vial and rotate it between the palms of your hands until
the serum is fully dissolved and let the vial stand
for serum to clear.
STORE IN A COOL DARK PLACE.
for 3 years. 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.
PREVENTION OF SERUM REACTION
Before injection of Anti-Snake Venom Serum it is necessary
to enquire from the patient:
- whether he has had injections of serum (eg. anti-tetanus
or antidiphtheria serum) before.
- 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 this 1:10
serum diluted . 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 1 ml 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 antihistaminics
such as antistine (100 mg.) and hydrocortisone (100 mg.)
intramuscularly 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 snakebite 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 intramuscularly 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
One dose vial of Sii Polyvalent Anti-Snake Venom Serum
(lyophilised) Central Africa, with 10 ml ampoule of Sterile
water for injection.