Statement All patients with Snakebite, confirmed clinically with neuroparalytic symptoms or non-clotting 20 WBCT are immediately provided Anti Snake Venom therapy

2. Rationale Anti Snake Venom therapy is the only specific treatment for snakebite cases. Once snakebite case confirmed based on clinical sign and symptom of envenomation or by lab test (20 WBCT) , ASV therapy should be started immediately without any other consideration. There are no contradictions to ASV. Early administration of ASV will stop the further progress of envenomation and even may reverse systemic envenomation abnormalities.

– If ASV is indicated i.e. signs and symptoms of envenomation with or without evidence of laboratory tests, administer full dose.
– There are no absolute contraindications to ASV.
– Do not routinely administer ASV to any patient claiming to have bitten by a snake as ASV exposes such patients to the risks of ASV reactions unnecessarily; besides wastage of valuable and scarce stocks of ASV. However, at the same time do not delay or withhold ASV on the grounds of anaphylactic reaction to a deserving case. Do NOT give incomplete dose.
– Purely local swelling, even if accompanied by a bite mark from an apparently venomous snake, is not a ground for administering ASV. Swelling, a number of hours old is also not a ground for giving ASV.
However, rapid development of swelling indicates bite with envenoming requiring ASV.

Antisnake venom (ASV)
– Antisnake venom treatment is the only specific treatment, should be given as soon as it is indicated. It may reverse systemic envenomation abnormality even when this has persisted for several days or, in the case of haemostatic abnormalities, persisting for two or more weeks. The dosage required varies with the degree of envenomation.
– In the presence of coagulopathy, Polyvalent ASV freeze-dried (heat stable; to be stored at cool temperature; shelf life 5 years) or neat liquid ASV (heat labile; requires reliable cold chain (2-8 degree celsius) with a refrigeration shelf life of 2 years) whichever is available may be used. If integrity of the cold chain is not guaranteed then use lyophilized ASV.
– ASV supplied in dry powder form has to be reconstituted by diluting in 10 ml of distilled water/normal saline (Figure 8). Mixing is done by swirling and not by vigorous shaking. #Caution: Do not use, if reconstituted solution is opaque to any extent.