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Reply To: Adder bite treatment

Emma Holt

Hi Annette,

The vetbytes app has a good research based summary of adder bites and how to manage. The summary suggests the following:

Initial investigations:
Haem, biochem, electrolytes, coags, ECG (arrhythmias are common but rarely require therapy).


IVFT is indicated in all cases. Hypotension may develop alongside distributive shock.

Anti-venom isn’t licensed and not indicated in every case. It reduces the severity of clinical signs, but it hasn’t been shown to affect the outcome. The adverse rxn rate is 7%, but anaphylaxis is rarely reported.
It’s indicated if:
Face or neck bite with significant swelling
If significant swelling extends proximal to next major joint.
If hypotension persists despite IVFT
If coagulopathies are present
If ECG abnormalities are present
It can be administered hours to days after bite, unless being used for local swelling when it should be given <24 hours, but this use is controversial.
Once administered swelling should reduce rapidly

Opioids should be used for analgesia and Nsaids avoided.

There’s no evidence/studies to support the use of anti-histamines, but as venom causes histamine release anti-histamines could be considered.

Wound care is needed to keep the wound clean and prevent patient licking, however antibiotics are rarely indicated.

There’s no evidence for benefits from steroids and they potentially increase mortality (by reducing the hosts response to antivenom).

Hope that helps.