์ด๋ฌด์ฌ ๋ค๊ฐ ํญ๋ ์
์ด๋ฌด์ฌ ๋ค๊ฐ ํญ๋ ์๋ ๋ถ๋ฏธ, ์ค๋ฏธ, ๋จ๋ฏธ์ ์ด๋ฌด์ฌ๊ณผ(์: ๋ฐฉ์ธ๋ฑ, ์ด๋ฌด์ฌ, ๋ฌผ์ด๋ฌด์ฌ, ํ๋ฅด๋๋์ค) ๊ต์ ์น๋ฃ์ ์ฌ์ฉ๋๋ ์ค์ํ๊ณ ์๋ช ์ ๊ตฌํ๋ **ํด๋ ์ **์ ๋๋ค. * **์ ํ**: **๋ง ์ ๋** ์ ํ(์ ์ฒด IgG ํญ์ฒด) ๋ฐ **์ ์ ๋** ์ ํ(Fab ๋จํธ, ์: CroFabยฎ)์ผ๋ก ์ ๊ณต๋ฉ๋๋ค. * **์ํ์ฑ**: ๋๋ฌผ์ฉ ๋ง ์ ๋ ์ ํ์ ์ต๋ 50%๋ ๋ง ์๋ถ๋ฏผ ๋ฐ ๊ธฐํ ๋จ๋ฐฑ์ง์ ํฌํจํ๊ณ ์์ด ๊ณผ๋ฏผ ๋ฐ์(์๋ํ๋ฝ์์ค)์ ์ฌ๊ฐํ ์ํ์ ์๋ฐํฉ๋๋ค. * **์์ ์์ **: ์ ์ ๋ Fab ์ ํ(CroFab)์ ์ธ์ฒด์ฉ์ผ๋ก ํ๊ฐ๋์์ผ๋ ์์ํ์์ ํ๊ฐ ์ธ(off-label)๋ก ์์ฃผ ์ฌ์ฉ๋ฉ๋๋ค. Fab ๋จํธ์ ์ ์ฒด IgG ๋ง ์ ๋ ์ ํ์ ๋นํด ์๋ํ๋ฝ์์ค ์ํ์ด ์ผ๋ฐ์ ์ผ๋ก ๋ฎ์ง๋ง, ๋ฐ๊ฐ๊ธฐ๊ฐ ์งง์ ๋ ์ฑ ์ฌ๋ฐ์ ๋ง๊ธฐ ์ํด ๋ฐ๋ณต ํฌ์ฌ๊ฐ ํ์ํ ์ ์์ต๋๋ค. * ์น๋ฃ์๋ ์ ๊ทน์ ์ธ ๋ณด์กด์ ์น๋ฃ๊ฐ ํ์ํ๋ฉฐ ๋น์ฉ์ด ๋งค์ฐ ๋ง์ด ๋ค ์ ์์ต๋๋ค.
์์ฉ ๊ธฐ์ : Antivenins provide **passive immunity** to the patient. * They contain concentrated serum globulins (or Fab fragments) obtained from animals (horses or sheep) hyperimmunized with pit viper venom. * **Mechanism**: The immunoglobulins directly bind to and neutralize the complex toxic proteins and enzymes present in the venom. * **Effect** โ Rapidly reverses venom-related systemic signs and coagulation abnormalities. * *Note*: Venom-induced thrombocytopenia, particularly from Timber Rattlesnakes, may be resistant to antivenin treatment.
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- Pit viper envenomation ยท 1-2 vials of antivenin. Initially, give one vial, by diluting to 100-250 mL of crystalloid fluids and initially administer by slow IV ยท IV ยท prn ยท Adjust infusion volume in smaller patients to prevent fluid overload.
- Systemic effects of envenomation ยท 1-2 vials slowly IV diluted in 250-500 mL saline or lactated Ringer's ยท IV ยท prn ยท Use only if necessary to treat systemic effects. Administer antihistamines; corticosteroids are contraindicated.
- Pit viper envenomation ยท 1-2 vials of antivenin. Initially, give one vial, by diluting to 100-250 mL of crystalloid fluids and initially administer by slow IV ยท IV ยท prn ยท Adjust infusion volume in smaller patients to prevent fluid overload. Intravascular bites or bites to torso/tongue require prompt, aggressive administration.
- Pit viper envenomation ยท 1-5 rehydrated vials (10-50 mL) IV depending on severity of symptoms, duration of time after the bite, snake size, patient size. Additional doses may be given every 2 hours as required. If unable to give IV, may administer IM as close to bite as practical. ยท IV/IM ยท q2h as required ยท The smaller the victim, the larger the dose (venom amount/kg is higher).
์ฉ๋์ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์ฐธ๊ณ ์๋ฃ์ ๋๋ค. ํญ์ ์ต์ ๋ผ๋ฒจ๊ณผ ๊ฐ๋ณ ํ์์ ๋ํด ํ์ธํ์ญ์์ค.
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- Known severe hypersensitivity to equine or ovine proteins (relative contraindication in life-threatening envenomation)
์ด์๋ฐ์
- Anaphylaxis (Type I hypersensitivity)
- Anaphylactoid reactions
- Serum sickness (Type III hypersensitivity, delayed)
- Nausea
- Pruritus
- Hyperemia of the inner pinna
์ฝ๋ฌผ ์ํธ์์ฉ
- Analgesics/Sedatives ยท May mask the clinical signs associated with the venom; use with caution initially.
- Antihistamines ยท Theoretical risk of potentiating venom, though diphenhydramine is routinely and safely used by clinicians for pre-treatment.
- Beta-blockers ยท May mask the early signs associated with anaphylaxis.
- Corticosteroids ยท Generally out of favor for treating snakebite envenomation, but may be useful to treat secondary anaphylaxis. Contraindicated in horses per some references.
- Heparin ยท Reportedly not effective in treating the thrombin-like enzymes found in rattlesnake venom.
๋ชจ๋ํฐ๋ง
- Signs associated with an allergic response (anaphylaxis, anaphylactoid-reactions, serum sickness)
- CBC with platelets
- Coagulation parameters
- Biochemical profile
- Hydration status
- ECG
๊ณผ์ฉ๋
Specific overdose information is not provided, but fluid overload is a significant risk in smaller patients receiving large volumes of crystalloid fluids used to dilute the antivenin.
VetSheet ์ฝ๋ฌผ ๋ ํผ๋ฐ์ค๋ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์์ฌ๊ฒฐ์ ๋ณด์กฐ ๋๊ตฌ์ด๋ฉฐ, ์ ๋ฌธ์ ํ๋จ์ด๋ ์ ์กฐ์ฌ์ ์ต์ ๋ผ๋ฒจ์ ๋์ ํ์ง ์์ต๋๋ค.