Template:Crofab dosing

• Administer antivenom as soon as possible if the indications are met and antivenom is available.
• Administration should slow swelling and decrease pain

Initial Administration

CroFab is reconstituted in normal saline and typically diluted into 250 cc or 1 L of normal saline and infused over an hour.

• The dosing of CroFab is the same for adults and children (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)
• Establish initial control of envenomation by giving 4-6 vials
• Control achieved? (Cessation of progression of all components of envenomation, including labs checked 2 hours after infusion started)
  • If yes: then perform serial exams and consider maintenance therapy
  • If no: repeat infusion of 4-6 vials and then re-evaluate for control

Maintenance therapy

• Maintance therapy may be indicated after initial dosing based on local protocols even if control is achieved.
  • Infuse 2-vial doses at 6, 12, and 18hr after initial control achieved

Envenomation control measurement

• Must observe for progression of envenomation during and after antivenom infusion
• Measure limb circumference at several site above and below bite
• Mark advancing border of edema q30min
• Repeat labs q4hr or after each course of antivenom (whichever is more frequent)

Antivenom Side Effects

• Acute allergic reactions occur in <10% pts
  • If occurs stop infusion and give epinephrine/antihistamines if needed
• Recurrent thrombocytopenia has been described up to 2 weeks after transfusion with FabAV and is likely a result of isolated renal clearance of FabAV and persistent presence of actual venom in serum.
  • Warrants close monitoring of platelets by primary physician or return visit after discharge
• Serum sickness is unlikely but precautions should be given to patents upon discharge