Though ASV was given as initial dose of 5 vials over 1 hour, it was repeated after 1 hour, again as an infusion over a period of 1 hour. We understand that ideal would have been to administer 8-10 vials as the initial dose but it was not feasible in our case due to some time spent in procurement of ASV.

Secondly, the maximum permissible dose of ASV to be given in a patient with neurotoxic snake bite is a definite area of controversy. There have been reports in literature depicting benefits of using much higher doses of ASV than 20 vials(1). Most of the studies quote end point of ASV as reversal of respiratory and neuromuscular paralysis. There has been no published case report of a neonate treated with ASV.

In our case, we were guided by the definite response to ASV in the terms of improving respiratory and neuromuscular paralysis even above the ceiling dose of 25 vials. We were hesitant to continue administering ASV after 25 vials of ASV and stopped intermittently but switched over to continue further doses in view of a good clinical response to ASV.