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What's up with Crofab use?
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by bwanadon on September 12, 2011
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A Maryland woman who looked to be in her late 30s or early 40s and healthy was just recently bitten on her thumb by a young copperhead (tip of tail still yellow). She was taken to a local hospital where she was administered 18 vials of Crofab!
While searching the WWW on the subject, someones 10 year old son was also fairly recently copperhead bitten and he got 14 vials to "stabilize him"!
An acquaintance of mine in his late 60s was bitten on the finger by a 4 foot Eastern Diamondback on the Georgia coast and on the way back to the Charleston, S.C. area decided the bite was serious and so detoured to the Beaufort Hospital where he was given 4 vials of Crofab and kept in hospital a total of 4 days (at least 2 days of that were not necessary - just for the doctor's curiosity). Apparently that physician had some idea of what he was doing.
Depending on your location, Crofab will be billed somewhere in the neighborhood of $2,000 - $4,000 per vial.
I'm beginning to wonder if the first two stories took place at facilities that had Crofab that was about to expire and other bills that needed funding.
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RE: What's up with Crofab use?
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by venomlover55 on September 12, 2011
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That is way out of hand. Not that i love talking about it but in the 13 years i have been keeping hots my hands are scared all over with agkistrodon after effects. I have never had to go to the ER for it. I have even had a couple cotton bites as well. The rattler i would absolutely take a trip to the ER with my bite protocol but for agkistrodon no way and certainly would never expect to receive that much not for a juvie or adult. With that species the odds are higher that there would be a worst side effect from the antiserum then from the bite. I know a few of the docs around here in my area and they almost always treat agkistrodon bites symptomatically with and IV and pain meds but almost never use Crofab unless they see no other choice as it can ad to the hospital stay time and risks to the victim of being allergic. So i do not get that at all.
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RE: What's up with Crofab use?
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by Crotalusssp on September 13, 2011
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Let's keep a couple things in mind. There are A LOT of variables to every bite. Snakes vary greatly, even within a species or even population, people vary in terms of reaction, size, medical history etc, bites vary in terms of location and venom volume. Add to this that a lot of medical personnel simply do not have experience with snake bites. It is facts like these that make it imperative that keepers arm themselves with as much information (bite protocols, emergency numbers, medical history, etc), and when possible A/V. Were the bite treatments less than perfect? Perhaps, but speculation should be used as an opportunity to learn, not necessarily to point fingers.
Stay safe,
Charles
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RE: What's up with Crofab use?
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by bwanadon on September 13, 2011
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Let's get real.
The attending physicians in these cases wasted a massive amount of Crofab and without doubt charged their patients accordingly.
My 6 year old son was bitten on the foot and the hospital put him on an antibiotic drip and monitored swelling with a Magic Marker as it progressed up his leg to the top of his thigh. He enjoyed his 3 day hospital stay because the nurses brought him ice cream whenever he asked for it.
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RE: What's up with Crofab use?
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by Crotalusssp on September 13, 2011
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How much of this was intentional mistreatment or simple ignorance on proper treatment. Very difficult to say.
Crofab does not have a long life in the body and envenomation effects can and have returned after initial treatment. That has to do with the biochemistry of the molecule itself.
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RE: What's up with Crofab use?
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by bwanadon on September 13, 2011
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Entirely correct...in truth excess Crofab will be relatively quickly removed by the kidneys and liver, so giving excessive amounts is still a complete waste.
With certain specific blood tests it is possible to precisely balance the effects of venom with the exact amount of Crofab (or other antivenins). Without such tests the same thing is possible, albeit with somewhat less precision, by simple observation of the progressive effects of the venom. The idea is a balance of the two substances. This was done with very effective results by the attending physician in the Beaufort, S.C. hospital in treating the Diamondback bite.
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RE: What's up with Crofab use?
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by Crotalusssp on September 13, 2011
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This kind of goes back to my original post. Most medical professionals are not experienced with snake bites. Best that keepers are as prepared as possible. Who really knows if they were intentionally using too much to get rid of it due to shelf life as someone suggested. It just seems to me a more likely answer is that they were not familiar with treatment and did what they believed was correct.
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RE: What's up with Crofab use?
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by bwanadon on September 13, 2011
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I would agree with the previous - almost. If the attending physicians are not knowledgeable in handling snakebites they might very easily have called another who they knew was knowledgeable. They could even have called the manufacturer to get specific instructions.
Crofab (Crotalidae Polyvalent Immune Fab (Ovine)) has even had some lots of reduced potency. Whether or not such lots were used in the two cases described is unknown.
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RE: What's up with Crofab use?
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by agkistrodude on September 14, 2011
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CroFab only stays in your system 6 hours. Venom can stick around for 30 or more. Also, many times, even if the bite is not severe enough to be fatal, like from a copperhead or pygmy rattlesnake, the CroFab can still save fingers and toes, hands and feet. My horridus bite took 23 vials and at the time,I was glad to have it. About every 5 hours, I could feel the effects of the venom returning, although a little less severe each time.At $900.00 per vial, it was expensive, but a far cry from $3K each. Take care, Marty
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RE: What's up with Crofab use?
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by bwanadon on September 14, 2011
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Actually in the few pre-marketing studies of Crofab the elimination half-life was between 12 and 23 hours, which means it would be eliminated completely between 24 and 46 hours.
$900 per vial represents a very low billing rate. Using 23 vials on a Timber Rattlesnake bite may well be another example of physicians who are not well versed in snake bite treatment.
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