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Solu-Medrol for Crotalid envenomation
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by pygmybait on April 13, 2006
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Hi everyone - First let me apologize for the length of this post . Here goes...
I'm still working on the treatment DVD that I've been talking about and something hit me. During my research I came across this:
"Ophitoxaemia leads to increase in the capillary permeability which may cause loss of blood and plasma volume into the extra vascular space".
Simple enough. Later that day, I happened to be reading up on Solu-Medrol, one of the drugs that my department carries and uses in several of our treatment protocols. The following is listed as one of the drug’s mechanisms of action…
"Reversal of increased capillary permeability"
See where I'm going with this? I asked my department's medical director if administration of this drug might help with the edema that we see after a pit viper envenomation, even though it may take several hours before the drug actiually begins to work (early, aggressive treatment). The Doc wasn't really sure.
So I called the Rocky Mountain Poison Control Center and asked the same question. The guy I talked to said that "prophylactic use of steroids is not currently recommended" I asked him WHY this was the case and all he could say was that it "isn't in the current protocols".
So my question to all of you is simple (although the answer may not be). Why?
It seems to me that early treatment with this drug may reduce the amount of swelling down the road which will, no doubt, help keep the pain associated with these bites to a minimuim. Speaking from my own experience - the bite hurts but the eventual swelling hurts 10 x as bad.
So can anyone think of a reason why pre-hospital administration of this drug would be contraindicated? The best that I can come up with is that some of the venom constituents that actually lead to the increased capillary permeability (enzymes and peptides etc...)work in a manner that a corticosteroid can't counteract.
Any thoughts?
Thanks in advance for your ideas and comments!
Matt
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RE: Solu-Medrol for Crotalid envenomation
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by Rabies on April 14, 2006
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Hi Matt, I gather this drug is a steroid?
As you mentioned steroids take a while to reach there full affect, now whether they would still have an effect while the venom is still circulating and causing damage to the cappilary walls, is another question! An appropriate amount of antivenom will also restore the cappilary walls, and probably quicker. Then allowing the body to slowly re-asborb the excessive fluid. Also steroids are immuno depressive and should really only be given to immuno reactions i.e serum sickness.
There has been excessive research on the uses of steroids in snake bite (sorry don't have any references at hand) and all the literature that I have read, recommends its use in allergic reactions, adrenalin of cause being the number one drug for anaphylaxis.
I'll try and find some ref material, if any one else has, please post. Thanks
John
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RE: Solu-Medrol for Crotalid envenomation
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by pygmybait on April 14, 2006
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I actually had another person from the RMPCC call me last night to explain it.
According to her, the main reason it isn't used is that clinical trials have shown that it just doesn't work. In theory and on paper it should but the onset just takes too long. By the time the drug takes effect, AV should already be on board and working.
Solu-Medrol would still be used for serum sickness and anaphylaxis.
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RE: Solu-Medrol for Crotalid envenomation
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by Phobos on April 14, 2006
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I concur with John's accessment. At the snakebite symposium the collective expertese present thought it should only be given to combat serious serum reactions.
Cheers!
Al
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