Adder Bites/ Anti Venom

Re: Adder Bites/ Anti Venom

Martin Jones — Wed, 12 Aug 2009 15:53:11 GMT

Toby

Excellent pics and a well-managed case - good work, mate. The slogs are always the most memorable ones.

But, you know, a little dex would have cleared that swelling up in half the time.........

Martin

Re: Adder Bites/ Anti Venom

Toby Birch — Wed, 12 Aug 2009 15:39:59 GMT

I have just uploaded a selection - sorry forgot about that facility. I don't seem to be able to get them into a single folder though.

Re: Adder Bites/ Anti Venom

Arlo Guthrie — Wed, 12 Aug 2009 14:31:47 GMT

[quote user="Toby Birch"]I have photos from both these cases and would be glad to share them with you if you let me have an email address.[/quote]

Could I persuade you to upload your photos to the 'Remarkable clinical cases' gallery here on VetSurgeon? (http://www.vetsurgeon.org/media/g/remarkable_clinical_cases/default.aspx)

Perhaps helpful for others to see too ...

Re: Adder Bites/ Anti Venom

Toby Birch — Wed, 12 Aug 2009 14:23:52 GMT

Not entirely sure what may make the BTG product superior. It was a human toxicology consultant that told me about the product but once I discovered that it was not available for veterinary use I gave up researching. It was going to make no difference to my patient at that time.

The product link is http://www.btgplc.com/MarketedProducts/287/ViperaTAb.html

Thanks for the vmd link.

Toby

Re: Adder Bites/ Anti Venom

Glen McIntosh — Wed, 12 Aug 2009 13:25:05 GMT

Here is a link to the VMD regarding avaiability and how to access supplies:

http://www.vmd.gov.uk/VetSQP/Viper_Venom.pdf

European viper antivenom was available breifly from Veterinary wholesalers earlier in the year, but stocks were limited.

Toby, what makes the BTG product superior?

Have you spoken to the VMD about this product? I was speaking to the VMD earlier in the year about antivenom, and they had asked to be informed of any alternative suppliers that were around, so they might be interested in what you have found?

Re: Adder Bites/ Anti Venom

Toby Birch — Wed, 12 Aug 2009 12:23:46 GMT

Karl,

This has caused me many headaches recently! The Zagreb antivenom that is always talked about and often obtained from the hospital seems to be completely unobtainable, and has been for the past year or so. Stocks are extremely low in this country and the Department of Health are not allowing any remaining stocks to be released to the veterinary market. I have had long discussions with the VPIS and NPIS all to no avail. The VPIS are pushing hard for stock to become available again.

There is potentially a more superior product called ViperaTab (made by BTG) but they do not have a license to supply vets. It also costs $2950 for 2 vials - made by US company hence dollars.

I have just spoken to NVS following Martin's post and am assured that they have some. I am currently waiting for them to fax me the date sheet. Given my previous findings I have to admit that I am somewhat dubious though. They tell me it is £47.29 per vial.

Fear not though....

The VPIS tell me that in only 5% of dogs NOT treated with antivenom is an adder bite fatal. Muzzle bites tend to be worse than leg bites. The beginning and the end of the season may also see worse bites.

I have dealt with 2 cases recently - the first a JRT used my remaining stock of (out of date) antivenom and the second, a cocker spaniel did not get any. Happily I can report both are doing well.

Treatment generally consists of IVFT to treat shock and maintain tissue perfusion, antihistamines initially, analgesia (pain may be considerable and I have found morphine infusions to be necessary), IV antibiotics - 1st or 2nd generation cephalosporin, and monitoring coagulation factors, renal and hepatic parameters. Given pain and the potential spread of bruising and oedema down the neck, blood sampling may be limited in the acute phase and you may wish to place a central line ahead of time. Obviously fresh frozen plasma can be given to correct coagulation if required (10-20ml/kg, approx £120 +vat per 200ml unit, available from the pet blood bank).

Steroids are not indicated as do not seem to alter the course of the antivenom and may promote sepsis.

It may take 5-7 before the oedema and bruising starts to subside.

I have photos from both these cases and would be glad to share them with you if you let me have an email address.

Hope this helps....and hope you don't have to deal with any bites.

Re: Adder Bites/ Anti Venom

Martin Jones — Tue, 11 Aug 2009 22:32:11 GMT

Karl

Re route of administration, I know some people do give i/v infusion, but I tend to give deep i/m, usually in divided doses. The fluids are for a bit of kidney flushing, counteracting the shock and to maintain a line in the event of drug reaction. I know some papers in human medicine quote up to 50% incidence of acute adverse effects.

We do give a 'healthy' dose of steroids at the same time - dose in these cases seems to be proportional to age of vet.

I know some people are a little shy of antivenom, but my own experiences have been positive - and that's what tends to drive our choices. I think of all the advice, to give a small amount first and then assess response is probably my first line.

Martin

Re: Adder Bites/ Anti Venom

Karl Collins — Tue, 11 Aug 2009 16:04:17 GMT

Martin,

Many thanks for a very helpful response email.

Just one question. Can you give the anti venom i/v as your email suggests or am I reading incorrectly.

I've cut and pasted some of your email for the rest of our vets as a protocol for adder bites should we see any. We've never actually had a case but I've heard of 3 people in last few weeks in our area having seen adders and I just wanted to be prepared.

Thanks again

Karl

Re: Adder Bites/ Anti Venom

Martin Jones — Tue, 11 Aug 2009 15:30:22 GMT

Karl

We see quite a few adder bites down here, so we always keep one in stock. Supply has been limited lately, but this should just be a blip; the usual sources will supply, although we have used the local hospital also.

The same product is indicated for both animal and human use (they've even changed the data sheet to take this into account). The dose is a vial per patient, but schedule of dosing can be a little complicated. We tend to use a whole vial for most patients - say from reasonable terrier size upwards, and half a vial for the teenies.

General method of admin is to put on a drip, inject half a ml first and observe for signs of anaphylaxis/adverse reaction, then follow up with the remainder 20-30 mins later. Although time is important, the real window of opportunity seems to be around 4 hours post-bite.

We also then follow up with urine and possibly blood samples for a few weeks

Couldn't tell you the shelf life, but we never seem to have one sticking around for more than a season in any case.

No doubt also, some enlightened soul hereabouts will inform us plebs that it's ancient and unproved medicine and makes the patient worse etc etc. We just know that we see quite a few, and we think they're better off having the dose than not.

Hope this helps

Martin

Re: Adder Bites/ Anti Venom

Utlendigur — Mon, 10 Aug 2009 22:50:58 GMT

I think NVS sell "Euroviper" antivenom for about £20-£25. No idea of shelf life etc sorry.