- Initial dose: 6 vials
- Typically diluted into 250 cc or 1 L of normal saline and infused over an hour
- Same dose for both adults and pediatrics (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)
- May repeat dose (2 vials) at 6, 12, and 18 hours later if symptoms not controlled
- Maintance therapy may be indicated after initial dosing based on local protocols even if control is achieved.
Envenomation control measurement
- Observe for progression of envenomation during and after antivenom infusion
- Measure limb circumference at several sites above and below bite
- Mark advancing border of edema q30min
- Repeat labs q4hr or after each course of antivenom (whichever is more frequent)
- 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