Anti Snake Venom

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The snake is one reptile animals are spread across the continent both species are venomous (harmless) or non-venomous species (not dangerous). Venomous snake that can produce to weaken the enemy or prey, as well as a means to defend themselves. Poison / venom will be injected in the body of its prey with a bite when he feels threatened, frightened or annoyed, or if the snake wanted to paralyze their prey.

Snake venom gland secretion is the result of a special mouth that resembles salivary gland in vertebrate animals, it can be said to be a snake is a modification of this saliva. Each species of snakes produce components and content of toxic materials or non toksi k are different. But if the snake has venom components of the family will like. Generally, any type of poisonous snakes contain hemoragin, kardiotoksin, and neurotoxins with different levels different.

Toxins are substances or compounds that enter the body in ways that inhibit the response of the biological system and can cause health problems, illness, even death. Often associated with food poisoning or chemicals. In fact not just food or chemicals that can cause poisoning. All around us there are natural toxins found in some plants and animals. One is a venomous snake bites are common in the tropics and subtropics. Given the still common poisoning due to snake bites can add it to our present knowledge of the community and help information about the dangers of venomous snake bites.Snakes are reptiles of many species found in Indonesia. Snake species can be distinguished by a poisonous snake and the snake is not poisonous. Venomous snakes have a pair of fangs in the upper jaw. At the canines are able to channel into the body can inject subcutaneously or intramuscularly prey.

Can is a substance or a substance that serves to immobilize prey and also play a role in self-defense system. Can such a modified saliva, which is produced by special glands. Glands that secrete could be a modification of the parotid salivary gland located at the bottom of each side of the head behind the eyes. Snake venom is composed only of a single substance, but it is a complex mixture, especially protein, which has enzymatic activity.

Toxic effect of snake venom when biting prey, depending on the species, size of the snake, sex, age, and the mechanical efficiency of the bite (if only one or two fang puncture the skin), as well as numerous attacks occurred. Including most poisonous snakes in the family Colubridae, but in general it produces can be weak. Examples include the family of this snake is a snake cow (Zaocys carinatus), the serpent rope (Dendrelaphis pictus) snake, rat or snake jali (Ptyas korros), and snake litter (Sibynophis geminatus).

Strongly that there is a poisonous snake in Indonesia usually belong to the family Elapidae, Hydropiidae, or Viperidae.Elapidae have short fangs and permanently erect. Some examples of these family members is a snake chili (Maticora intestinalis), weling snake (Bungarus candidus), cobra (Naja sumatrana), and the snake king cobra (Ophiophagus hannah).

Viperidae have long fangs that normally can be folded into the upper jaw, but can be enforced when it is attacking its prey. There are two subfamily of the Viperidae, ie Viperinae and Crotalinae. Crotalinae have organ for detecting warm-blooded prey (pit organs), which lies between the nostrils and eyes. Some examples are the Viperidae snake bandotan (Vipera russelli), land snake (Calloselasma rhodostoma), and the carcasses of sea snakes (Trimeresurus albolabris).

The chemical composition of snake venom is a complex of about 90% composed of proteins that are predominantly enzymes and contain polypeptides, enzymes such as snake venom major proteolytic, hialurinidase, amino acid oxidase, cholinesterase, phospholipase A, ribonuclease, deoksiribonuklease, fosfomonoeterase, phosphodiesterase, nukleotidase , ATPase and DPNase.

Constituent proteins of snake venom if injected into the bloodstream and affects the cardiovascular system, circulatory, respiratory, nervous. To overcome the poisonous snake bites snake antibisa then used directly injected into a vein.Antibisa snake serum or antibodies are produced to neutralize the effects of snake venom extract the infection. Serum was obtained by injecting venom that has been attenuated to the horse's body.

There are two types of snake venom, which is

1. Neurotoxins: May paralyze the central nervous system, paralyzing the heart and respiratory sarah. Toxins of this type is owned by Cobra snake, mamba snake, sea snake, Krait, the Coral Snake.
2. Hemotoksin: Can invade the blood circulatory system and muscular system and can cause tissue damage, gangrene, permanent paralysis of the muscles moving Traffic. This type of toxin produced by the family Viperidae snakes such as Rattle Snake, Coppe head, and Cotton mouth.

Until now about 20 known types of enzymes that are toxic. Poisonous snakes generally have 6 to 12 types of enzymes in the venom. Each special function, for example, to digest the prey, whereas the other enzymes to immobilize prey.

Several types of enzymes that have a poisonous snake:

• Cholinesterase: neurotoxins and can paralyze prey
• Amino Acid oxidase: Functioning digest prey and trigger another enzyme role.
• Hyaluronidase: Serves to facilitate the absorption of other enzymes kejaringan victims.
• Proteinases: Function to digest, mengahancurkan victim's body tissue.
• Adenosine Triphospatase: Suspected centrally acting neurotoxin and causes the victim into shock and immobilize prey.
• Phospodiesterase: Works by interfering with heart function and lower blood pressure quickly.

Savor the Snake Serum
poisonous, especially the snake venom, does have a deadly nature. Snake venom alias was very fierce. Therefore, the snake venom can rapidly paralyze the nerves of the victim (eurotoxin). Or there is also a snake venom that is crippling the blood circulation system (hematoxin). However, the nature of the poison that kills it turned out to be useful for humans.Therefore, aka snake venom serum were also able to kill many germs. According to Hunter Snake Club Indonesia (SHCI), an organization snake lovers who also developed the use of snake serum in Indonesia, there are a number of diseases can be cured snake serum. As mentioned in the first paper, snake serum is composed of three classes. Each class has a property and how it works on their own.

Mildest venom serum, ie, class III, to cure various diseases caused by viruses, such as malaria, dengue, and rabies.Understand it, "Sera third grade is going to kill a wide range of viruses that enter the body, so patients can be healthy again," and make us immune to the disease malaria, tetanus, rabies, and when accidents, quickly wound dry, clear Transtoto Handadhari , Chairman of the Board of Trustees Snake Hunter Club Indonesia. Serum class III can be made from water snake, talimongso, gadung, Koros, python, python Manuk, python flowers, rice, bran, blandotan filigree, puspa awning, and samberlilen. In addition, said Transtoto, the mildest venom serum will also help speed up the drying of the wound - the wound caused by vehicle accidents.

Class II serum useful for curing various diseases related to blood. Therefore, serum venom of the middle class is going to clean the blood of various harmful substances. Serum class II, which is made of striped snake venom as gibuk, Bungarus fasciatus, weling, and gadung Luwuk Several types of diseases can be cured by a serum class II include diabetes (diabetes mellitus), typhoid fever, liver, asthma, and allergies.

Serum levels of I, which comes from the most dangerous snake, believed to cure a variety of severe diseases like blood cancer, bird flu, bone cancer, to HIV. and immune to the bites King Cobra. Serum highest grade I was serum class I made from snake venom really? as dangerous, Cobra venom and bran Bromo. There are patients who are HIV virus was lost after drinking this I serum levels, "said Transtoto.

In the UK and Australia there are studies that say the snake serum to prevent heart attacks and strokes. Unfortunately, the study is still at a stalemate despite being 25 years running. The problem they face is the difficulty of determining the proper dose of serum in order to function properly and instead of poisoning the body of the patient. That is one reason why until now the benefits and use of snake serum in the world of modern medicine is still a debate to the experts.However, a clear, Transtoto claim, to this day, at least 40,000 people have felt the benefits of artificial SHCI snake serum. And, so far, "There is not one case of patient serum so poisoned after drinking a snake," he said.

Meanwhile, according to snake venom serum manufacture SHCL degan how the process of making all three types of serum was not too complicated. Live snake venom removed and dried in the sun to crystallize. Well, if you want to use, the crystals can be re-melted snake. How to use it is drunk. Composition, one tablespoon of snake serum plus half a glass of water. This method is different from the use of snake serum in the hospital to treat patients bitten by snakes.Amazingly, someone who never drank or receive an injection of immune serum against snake will bite the corresponding lifetime. For example, if you accept a snake serum weling, your life will be immune to snake bites weling any type.

The method of making these different serum Serum-making procedures in the clinic. Preparation of serum in our clinic as an explanation at the beginning of this article is to inject venom that has been weaken in horses, so horses form antibodies and antibody such as horse serum. Either we do not really know about it. But we think the most plausible is the manufacture of serum in the clinic. But how SHCL also acceptable because the venom contains a protein such as egg yolk protein and when eaten / will go through the digestive organs to digest naturally, but the question is what is right after a meal of snake venom proteins will form the anti-body in our bodies?

Egg yolks are also technically very dangerous and has similar effects to the snake if the yolk was directly injected into the vein. If this happens there will be blood clots as a form of reaction between the yolk and blood.

METHOD OF MAKING ANTI CAN / SERUM
venom is very dangerous, triggering a human to make the antidote. Antidote to snake venom called antitoxin or antivenin produced by the method of 'Horse Serum (horse serum).'
Can Serum Anti Snake (polyvalent) Horses (1)
Description
- Chemical Name and Structure: Serum polyvalent anti-snake venom (horse)
- physicochemical properties : -
- Description: polyvalent serum derived from horse plasma dikebalkan against snake venom has neurotoxic effects (Naja type snake sputatrix - cobras, Bungarus fasciatus - striped snake) and hemotoksik (Ankystrodon rhodostoma snake - a snake of land)

Antivenom (or antivenin or antivenene) is a biological product used in the treatment of venomous bites or stings.Antivenom was made by flushing toxins from the desired snakes, spiders or insects. The venom is then diluted and injected into the horse, sheep or goats. Animal subjects will undergo an immune reaction to the venom, producing antibodies against the active toxin molecule can then be harvested from the animal's blood and used to treat envenomation. Internationally, antivenoms must comply with pharmacopoeia standards and World Health Organization (WHO)

Horse Serum: The venom is injected into the body of a horse, a berlahan will form antibodies against snake venom.Separated from the blood serum of horses.

But the third recipient of the horse serum had a reaction because it is necessary alergi.Oleh standard procedure for serum sensitivity before menuji given to patients with snake bites.

In addition to produce antivenin, snake venom it can be used for health and other medical fields, such as:

• . Copperhead Snake Toxins: Treating patients with breast cancer
• Malayan Pit Viper venom: Dimanfaatka to prevent blood clotting, may be beneficial for patients sroke
• Cobra venom enzyme: under investigation for mencegar Parkinzon disease, Alzheimer, as well as leukemia and cancer.
• Viper Snake venom: Suspected to treat osteoporosis and reduce the specific tumor
• Some types of snake venom extracts used for anticoagulation, disease, cure heart disease or high blood pressure.

Antivenom serum antibisa terminology or
name "antivenin" venin derived from the French word, which means poison, which in turn comes from the Latin venenum, which means poison. Antivenin historically predominant in the whole world. The first published use of the term was a in 1895. In 1981, the World Health Organization decided that the preferred term in English would be a poison and antivenin antivenom than venin and or venen and antivenene.

Therapeutic use of
antivenom is based on the principle of the vaccine, developed by Edward Jenner, however, instead of directly stimulating the immune response in patients, induced in the host animal and the hyperimmunized serum is transfused into the patient.

Antivenoms can be classified into monovalent (when they are effective against certain species venom) or polyvalent (when they are effective against a variety of species, or different species at the same time). The first antivenom for snakes (called anti-ophidic serum) was developed by Albert Calmette, a French scientist Pasteur Institute working at its Indochine branch in 1895, against the Indian Cobra (Naja naja). Vital Brazil, a Brazilian scientist, developed in 1901 monovalent and polyvalent antivenoms for the first Central and South American Crotalus, Bothrops and Elaps genera, as well as for some types of poisonous spiders, scorpions, and frogs. They all developed at the institute Brazil, Instituto Butantan, located in São Paulo, Brazil.

Antivenoms for therapeutic use is often preserved as freeze-dried ampoules, but some are only available in liquid form and must be stored in the refrigerator. They did not immediately inactivated by heat, however, so a small gap in the cold chain is not disastrous. The majority of antivenoms (including all snake antivenoms) are administered intravenously, but the stonefish and Redback spider antivenoms are given intramuscularly. Intramuscular route has been questioned in some situations are not uniformly effective.

Antivenoms bind and neutralize the poison, to stop further damage, but do not reverse damage already done. So, they should be given as soon as possible after the poison has been injected, but from some of the benefits for toxins present in the body. Since the advent of antivenoms, some bites had always been fatal had become only rarely fatal provided that antivenom is administered soon enough.

Antivenoms purified by several processes but will still contain other serum proteins that can act as an antigen. Some individuals may react to the antivenom with immediate hypersensitivity reactions (anaphylaxis) or delayed hypersensitivity (serum sickness) reaction and antivenom should, therefore, be used with caution. Although this caution, antivenom is usually the only effective treatment for life-threatening condition, and all precautions to manage these reactions are in place, anaphylactoid reaction is not a reason for refusing to give antivenom if otherwise stated. Although it is a popular myth that people who are allergic to horses "can not" be given antivenom, side effects can be controlled, and antivenom should be given as soon as side effects can be managed.

In the U.S. the only approved antivenom for pit viper (snake, Copperhead and water moccasin) snakebite is based on a pure product made ​​in sheep known as CroFab. It was approved by the FDA in October, 2000. U.S. coral snake antivenom is no longer manufactured, and the stock remaining in-date antivenom for coral snake bites ended in the spring of 2009, leaving the U.S. without a Coral snake antivenom. Efforts are being made ​​to get approval for the coral snake antivenom produced in Mexico that would work against U.S. coral snake bites, but approval is still highly speculative. In the absence of antivenom, all coral snake bites should be treated in hospital with endotracheal intubation and mechanical ventilation until the effects of elective coral snake neurotoxins abate. Important to remember that the respiratory paralysis of coral snake bites can occur suddenly, often up to 12 hours or more after the bite, so intubation and ventilation should be used to anticipate respiratory failure and not after it happens, when it may be too late.
Natural and acquired immunity

Although individuals may differ in their physiopathological response and sensitivity to animal venoms, there is no natural immunity to those in humans. Some ophiophagic animals immune to the toxins produced by several species of venomous snakes, by the presence of antihemorrhagic factors and antineurotoxic in their blood. These animals include Kingsnakes, opossums, mongooses, and hedgehogs.

It is quite possible to immunize a person directly with small and graded doses of poison than the animals. According to the history of Greece, King Mithridates did this to protect themselves against the attempts of poisoning, so the procedure is often called mithridatization. However, unlike a vaccination against a disease that only have to produce a latent immunity that can be raised if there is infection, to counteract the sudden and large doses of venom requires maintaining a high level of circulating antibodies (hyperimmunized state), through repeated venom injections (typically every 21 days).Long-term health effects of this process has not been studied. For some large snakes, the total amount of antibody is likely to retain a single human being is not enough to neutralize one envenomation [citation needed ]. Further, cytotoxic venom components can cause pain and scarring of the small on-site immunization. Finally, the resistance is specific to certain toxins that are used; maintain resistance to a variety of venoms requires multiple monthly venom injections. Thus, there is no practical purpose or favorable cost / benefit ratio is, except people like zoo handlers, researchers, and circus artists closely connected with venomous animals. Mithridatization has been successfully tested in Australia and Brazil and total immunity has been achieved even a few bites of venomous cobras and pit vipers. Beginning in 1950, Bill Haast successfully immunized himself to the venoms of Cape, India and the king cobra

Because neurotoxic venoms must travel far to commit crimes in the body and is produced in a number of smaller, more easily develop resistance to them rather than directly cytotoxic venoms (like the majority of poisonous snake) is injected in large numbers and do the damage immediately after the injection.

Snake Bites How Can Happen?Victims of snake bites are mainly farmers, farm workers, fishermen, snake charmer, a hunter, and a snake catcher. Most snake bites occur when people are barefoot or wearing only sandals and accidentally stepped on a snake. Snake bites can also occur in the household, when the snake entered the house to look for other prey in the form of snakes, lizards, frogs, or mice.

How to Recognize Venomous Snakes?
There is no simple way to identify poisonous snakes. Some non-venomous snake species may seem like a venomous snake. However, some poisonous snakes can be identified by size, shape, color, habits, and the sound emitted when feeling threatened. Some features of venomous snakes is a triangular head shape, the size of a small canine teeth, and bite wounds in a former fangs.

The characteristics of non-venomous snakes:
1. Rectangles form the head
2. Small canine teeth
3. Bite: the arch-shaped smooth cuts

The characteristics of poisonous snakes:
1. Triangular head shape
2. Two large canine teeth in upper jaw
3. Bite mark: two major bite wounds caused by canine

Nature could, Symptoms, and Signs Snake biteson the body by its prey, venom can be distinguished became able hemotoksik, which can affect the heart and the vascular system: it could neurotoxic, which can be affecting the nervous system and brain; and can be cytotoxic, yaitu can only work on the site of the bite. Not all venomous snakes can inject when biting the victim. People who are bitten by snakes, although none could be injected into his body into a panic, breathing becomes rapid, hands and legs become stiff, and his head became dizzy. Symptoms and signs of snake bite will vary according to species number of snakes that bite and can be injected to the victim. Symptoms and signs include canine bite marks (fang marks), local pain, local bleeding, bruising, swollen lymph nodes, sore, blister, local infection, and tissue necrosis (mainly due to snake bites from the family Viperidae).

CLINICAL SYMPTOMS IN venomous snakebites:

1. In general, there will be local symptoms and systemic symptoms at all snake bites.
2. Local symptoms: edema, tenderness at the bite wound, ecchymoses (dark skin because the blood is trapped in the tissues under the skin).
3. Systemic symptoms: hypotension, muscle weakness, sweating, chills, nausea, hypersalivation (multiply saliva), vomiting, headache, blurred vision

Elapidae bites (eg, cobra, snake weling, Bungarus fasciatus snake, cobra, King Cobra, snake chili, coral snakes, mambas, kraits)

1. Shot of the cobra in the eye can cause a throbbing pain, stiffness of the eyelids, swelling around the mouth.
2. Picture of severe pain, blisters, and skin damage.
3. Once bitten by a snake
   a. 15 mins: systemic symptoms appear.
   b. 10 hours: paralysis of the veins on the face, lips, tongue, throat, so it is difficult to speak, difficulty swallowing, muscle weakness, decreased eyelid, headache, cold skin, vomiting, blurred vision, numbness around the mouth.
   Death can occur within 24 hours.

Bite Viperidae / Crotalidae (snake: snake soil, green snake, snake bandotan Puspo):

1. Local symptoms occur within 15 minutes, or after several hours of swelling near the bite that spreads throughout the body member.
2. Systemic symptoms appeared after 5 minutes or after several hours.
3. Severe poisoning characterized by swelling in the elbow and knee in 2 hours, or characterized by severe bleeding.

Hydropiidae bites (for example: the sea serpent):

1. Immediately headache, thick tongue, sweating, and vomiting.
2. After 30 minutes to several hours usually occur rigid and thorough pain, dilated pupils, jaw muscle spasm, muscle paralysis, mioglobulinuria marked with dark brown urine (this is important for diagnosis), kidney damage, cardiac arrest.

Rattlesnake bites and Crotalidae (eg: land snakes, green snakes, snake bandotan Puspo)

1. Local symptoms: found canine bite marks, swelling, ecchymoses, pain in the bite area, all of these indications of the need crotalidae polyvalent antivenin.
2. Anemia, hypotension, thrombocytopenia.

Snakebite pain may arise from biogenic amines, such as histamine and 5-hydroxytryptamine, which is found in Viperidae.Compartment syndrome is one of the specific symptoms of venomous snake bites, which occur edema (swelling) of the legs are marked with the 5P: pain (pain), pallor (pallor), paresthesia (numbness), paralysis (muscle paralysis), pulselesness (pulses) .

Management of snake bite poisoning is a result ofsteps to be followed in the management of snake bites are:

A. First aid, should be implemented immediately after a snake bite before the victims were taken to hospital. This can be done by the victims themselves or others at the scene. The purpose of first aid is to inhibit the absorption can, preserve life and avoid complications before the victim received medical treatment at the hospital and watching some early signs of harm. Then immediately take affected person to medical care.

Method that does is help to calm the anxious victims; immobilization (makes no movable) body part bitten by tying or propping the wood to prevent muscle contraction, because movement or muscle contraction can increase the absorption into the bloodstream and lymph nodes; consider pressure - immobilisation in Elapidae bites; avoid disruption to the bite wound because it can increase the absorption and can cause local bleeding.

Treatment Before she was taken to the hospital:

• Rested in the horizontal position of the bite wound
• If not available antibisa, tie two ends are exposed to the bite. This action is less useful if performed more than 30 minutes paskagigitan.

2. Victims should be immediately taken to hospital as soon as possible, in a safe and comfortable as possible.Avoid movement or muscle contraction to prevent an increase in absorption can.

3. Treatment of snakebites generally occur misunderstanding regarding the management of snake bites .Methods of use of tourniquets (tied so hard that inhibits blood circulation), incision (incision with a sharp instrument), suctioning the bite, the bitten area cooling, giving antihistamines and corticosteroids should be avoided because no proven benefit.

4. The recommended therapy include:

1. Clean the wound with sterile water or fluid physiology.
2. Local effects of immobilization is recommended for use with a wide elastic bandage cotton + 10 cm, length 45 m, which was wrapped around a solid body part bitten, starting from the toes to the section closest to the bite. Wrap tightly with a bandage like wrap a sprained foot, but not too tight ties to the blood flow is not disturbed. The use of tourniquets are not recommended because it can interfere with blood flow and release of tourniquets can cause more severe systemic effects.
3. Provision of support in the form of stabilization measures, including airway management; management of respiratory function; management of circulation; management of resuscitation should be carried out if the clinical condition of the victims of severe hypotension and shock, shock, bleeding, nerve paralysis, respiratory condition deteriorated due to sudden release of pressure dressings, hiperkalaemia due to damage to skeletal muscle, and kidney damage and local necrosis complications
4. Giving a tetanus shot, or if the victim never received a single dose of toxoid administered the tetanus toxoid
5. Giving injections of crystalline penicillin 2 million units intramuscularly
6. The provision of sedation or analgesic to relieve the fear of early death / panic
7. Giving antibisa serum. Because the venom is composed largely of protein, the antigenic nature is so it can be made from horse serum. In Indonesia, antibisa is polyvalent, which contains antibodies against several snake venom.Serum antibisa is only indicated if there is extensive local tissue damage

Once taken to the hospital:
Give Sabu (Serum Anti Could Snake) polyvalent 1 ml contains:
1. 10-50 LD50 could Ankystrodon
2. 25-50 LD50 could Bungarus
3. 25-50 LD50 could Naya sputarix
4. Phenol 0.25% v / v.

Giving Techniques:
2 vial @ 5 ml intravenously in 500 ml NaCl 0.9% or Dextrose 5% with a speed of 40-80 drops per minute. A maximum of 100 ml (20 vials).

Inform patients about possible side effects are delayed, mainly serum sickness (fever, rash, arthralgias). First action on snake bites:

1. The wound was washed with water or with a solution of potassium permanganate to eliminate or neutralize snake venom that has not terabsorpsi.
2. Incision or excision of the wound is not recommended, unless the new snake bites occur a few minutes earlier.Incision wounds made in haste or performed by an inexperienced person actually seing damage the tissue under the skin and will leave a substantial scar.
3. The bitten limb immediately tied to the spread of venom.
4. Perform then the bitten limb immobilization by placing a splint because it may accelerate the spread of muscular movements toxins.
5. If the bitten limb may be cooled with ice cubes.
6. Patients are prohibited from moving and if necessary can be given analgesics or sedativa.
7. Patients should immediately be brought to the doctor or the nearest hospital to receive further treatment.

Dose, and the Old Method of GivingSelection of anti-snake venom depends on the species of snake bite. The right dose is difficult to determine because it depends of the amount of venom entering the circulation of the blood of victims and victims of circumstances when receiving anti-serum. The first dose of 2 ml vial @ 5 as a 2% solution in physiologic saline can be administered as an infusion with a speed of 40-80 drops per minute, and then repeated every 6 hours. If necessary (for example the symptoms are not reduced or increased) anti-serum can continue to be given every 24 hours up to a maximum (80-100 ml). Anti-serum is not diluted can be given directly as an intravenous injection very slowly. Doses of anti-serum for children equal to or greater than the dose for adults.

Storage stability antibisa Serum
Kept at a temperature of 2-8 ° C in the refrigerator, not in the freezer. The expiry date = 2 years.

Serum antibisa Contraindications
There are no absolute contraindications to anti-snake venom therapy for systemic envenoming real; therapy is required and is usually used to save lives.

Side Effects Serum Antibisa.

1. Anaphylactic reaction; rare, but if there can be immediate onset or within a few hours after injection.
2. Serum sickness; can occur 7-10 days after injection of a fever, rash, exanthema, shortness of breath and other symptoms of allergies.
3. Fever with chills that usually occur after administration of intravenous serum.
4. Pain at the injection site, which usually occur on the injection of large amounts of serum. These reactions usually occur within 24 hours.

Interaction

1. With Other Drugs: No significant interactions were reported.
2. With Food: -

Influence

1. Against Pregnancy: There are no data regarding the use of anti-snake venom in pregnancy. Advantages of use of maternal and infant risk than the possibility of the use of anti-snake venom serum.
2. Against Breastfeeding: No data. The use of capital gains exceed the possible risks to the baby.
3. Against Children: Children have a greater risk of severe envenoming because of smaller body mass and the possibility of greater physical activity. Children need the same dose to adults, and children should not be given weight-based doses (pediatric dose weight-adjusted); because this can lead to a lower dose estimates. The number of anti-snake venom serum is needed depends on the amount of venom that need to be neutralized rather than a patient's weight
4. Results of the Laboratory: -

Monitoring Parameters
Monitor the effects of anti-snake venom serum, both clinically and laboratory. Monitor side effects after administration of anti-snake venom serum. Monitoring is required may vary depending on the type of snake bite. When in doubt about the type of snake bite, monitor coagulopathy, flaccid paralysis, myolysis and renal function.

Dosage form
Vials 5 ml, Each ml preparations can neutralize:

• 10-15 LD50 Can Snake Land (Ankystrodon Rhodostoma)
• Can LD50 25-50 Striped Snake (Bungarus fasciatus)
• Can LD50 25-50 cobra (Naja Sputatrix), and phenol containing 0.25% v / v

Anti-snake venom should be given immediately after the above signs or symptoms are found. Anti snake venom will neutralize the effects of snakebite has occurred despite a few days ago or in the case of hemostatic disorders, anti-snake venom can still be given even when there is more than 2 weeks. But some clinical evidence that anti-venom to mention effective if given within a few hours after being bitten by a snake.

More than 10% of patients experienced hypersensitivity reactions to anti-snake venom, the reaction can trejadi rapidly (within hours) or later (5 days or more). The risk of a reaction depends on the dose given, except in rare cases, there was sensitization (IgE-mediated type I hypersensitivity) by the serum of animals before, for example:-tetanus Ig, Ig-rabies.

Anaphylaxis reactions
occurred within 10-180 minutes after administration of anti-snake venom, symptoms are itching, urticaria, dry cough, fever, nausea, vomiting, diarrhea and tachycardia. Minority of patients will experience a severe anaphylactic reactions such as hypotension, bronchospasm and angioedema.

Pyrogenik reaction (endotoxin)
occurs within 1-2 hours after treatment, symptoms include fever, vasodilation and decreased blood pressure. This reaction is caused by pyrogen contamination during the process dipabrik.

Slow reaction
occurs within 1-12 days after treatment, clinical symptoms include fever, nausea, vomiting, diarrhea, itching, recurrent urticaria, arthralgia, myalgia, limpadenopati, proteinuria with immune complex nephritis, and encephalopati (rarely).

Treatment of reactions that occur after administration of anti-snake venom
anaphylactic reactions and anti-snake venom pyrogen
Epineprin (adrenaline) is given intra-muscular (lateral upper thigh) with an initial dose of 0.5 mg for adults and 0.01 mg / kg for children. Adrenaline should be given immediately after the onset of symptoms, the dose may be repeated every 5-10 minutes if the condition does not improve.

An additional form of antihistamines, anti-H1 blockers such as klorphenamin maleate (10mg adult, children 0.2 mg / kg IV in a few minutes) should be administered with hydrocortisone (100 mg adult, children 2mg/kgBB). In the reaction can be given anti piretik pyrogens (eg oral paracetamol or supp). Intravenous fluids should be given to overcome hypovolaemia.

Slow reaction (serum sickness)
Anti histamine administered orally for 5 days, if no response within 24-48 hours given prednisolone for 5 days.

Dose: chlorphenamine: adult 2mg / 6 hours, children 0.25 mg / kg / day

Prednisolone: ​​adults 5mg / 6 hours, children 0.7 mg / kg / day

ConclusionsSerum Anti Snake Can (Anti Snake Venom) is a biological product used in the treatment of venomous snake bites. Anti snake venom contained in the two preparations, monovalent (effective against certain species of snake venom) and polyvalent (effective against several species of snakes). Anti-venom is given when a patient is proven or suspected to have been bitten by a snake with a sign of systemic or local toxicity.