Recurrence phenomena after immunoglobulin therapy for snake envenomations: Part 2. Guidelines for clinical management with crotaline Fab antivenom

Ann Emerg Med. 2001 Feb;37(2):196-201. doi: 10.1067/mem.2001.113134.


Recurrent local and coagulopathic effects (worsening after clinical improvement) have been described after treatment with Fab antivenom for envenomation by North American crotaline snakes. Although similar phenomena have been described previously in snakebite, few studies have examined recurrence or its management. Recurrence is consistent with known venom and antivenom kinetics and dynamics. The clinical significance of late coagulopathy after snakebite is uncertain, but clinically significant bleeding is a possibility. Prevention and treatment of recurrence with Fab antivenom require repeated dosing for at least 18 hours, with close monitoring of at-risk patients in the follow-up period. Duration of therapy depends on individual risk factors and coagulation response.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aftercare / methods
  • Algorithms
  • Animals
  • Antivenins / adverse effects*
  • Antivenins / metabolism
  • Blood Coagulation Disorders / etiology*
  • Blood Coagulation Disorders / prevention & control*
  • Decision Trees
  • Disease Progression
  • Drug Monitoring / methods
  • Humans
  • Immunoglobulin Fab Fragments / adverse effects*
  • Immunoglobulin Fab Fragments / metabolism
  • Patient Selection
  • Practice Guidelines as Topic*
  • Recurrence
  • Risk Factors
  • Snake Bites / blood
  • Snake Bites / immunology
  • Snake Bites / physiopathology
  • Snake Bites / therapy*
  • Time Factors
  • Viperidae* / immunology


  • Antivenins
  • Immunoglobulin Fab Fragments