Very nice and wonderful post my dear Dr Abdul Khaliq, This is very much possible after snake bite which results in severe necrosis and premature death of cells. In general this is possible when the case is not properly treated. The doctor treated her might have missed Polyvalent Anti venom and might have treated with symptomatic treatment and probably with antibiotics. This necrosis may some times be very fatal leading to Rhabdomyolysis and resulting in Kidney damage, AKI and death. Treatment. This leg needs A/K amputation. But in spite of amputation also the patient may die because of snake poison. This stands a best example for negligence. Where ever it happened, how ever it happened, this is because of the negligence on the part of patient as well as the treating doctor. Thanks again dear Abdul Khaliq for a rare post.

thanks sir for your valuable suggetions

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Dear Shaurya Pratap, You can go through this please.

Excellent dear Dr Krishna Mohan sir

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Dear Shankar, Wonderful question indeed. As per the international guidelines by WHO ASV must be given before 4 hours which yield the best results. Maximum time is before 24 hrs of the bite. ASV becomes useless after 24 hrs of bite. So ideal time is before 4 hrs. Worst case before 24 hrs. Not useful after 24 hrs.

How much And how to give ASV

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Dear Neetha Kochar, There is no fixed dose schedule for ASV. It purely depends on the requirement of the individual patient. We need to mix the powder dissolved in DW or NS just before administration. This should be given by IV. Initial dose is 100 to 200 ml IV f/b 50 ml IV 6th hourly until the patient recovers. But always give test dose before giving this IV, because this some times causes anaphylactic shock because ASV is raised in Horse Serum. So be careful with ASV. Without test dose never give ASV.

sir sorry to interrupt but dosage shud be in mg.as the asv is in powder form.how many vials to give loading. in how much ns or DW to dilute?

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Dear Dr Khaliq, This is a rare presentation and really very unfortunate for the victim. The leg would have to be sacrificed for this avoidable negligence. The maximum effect of the poisoning has already set in the leg itself and only amputation can give some hope of survival. This has happened bcz of the effect of poison in causing total obliteration of the blood vessels by causing vasoconstriction and thrombosis resulting in dry gangrene.

Horrifying picture Possible in snake bite ifnot treated properly . If not treated with antivenom in time ,in some deadly poisonous snake bite this may happen. This is due to necrosis of leg followed by snake bite This may lead to rhabdomyolysis and kidney failure and death Above kneee Amputation is the leftover option of treatment .Still the patient may die because of snake venom poison

Dear Dr Krishna mohan sir, Is there any particular time period after which ASV in a snake bite is not much useful..?

Answered your question

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Dear Dr Krishna Mohan sir, My doubt in dis s, since ASV s not given in time, so dis complication has occurred.. Agree.. But, s der any possibility, tat even after giving ASV dis complication can occur?????? And wat s d survival rate of dis pt. After AK amputation???

Excellent doubt dear Velu, This happens even after envenomisation too. If anti venom is given late, this might happen. Even after Amputation too, survival is a million dollar question. May be because of the venom, may be AKI death is possible.

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Thank you so much Krishna sir for teaching us about the critical time period for administration of ASV.. A very good post and a very good discussion sir..

U R most welcome dear Arnab

Dear Dr.Krishna Mohan Sir.. Please take a look at this.. Is this correct? I mean no test dose before giving ASV?

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