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.
Reference
1. Agrawal PN, Aggarwal AN, Gupta D, Behera D,
Prabhakar S, Jindal SK. Management of respiratory failure in severe
neuroparalytic snake enveno-mation. Neurol India 2001; 49: 25-28.