<prompt> Indication for administration of AS V Antisnake venom in Viper bite?Renal failureDICSoft tissue swelling crossing joint nearby the site of biteAll of the above  <response>: Ans. d All of the above Ref: Pilley Textbook of Toxicolgy 7th edition, p. 450; Harrisons 17th ed., p. 2742Use of Acetylcholinesterase Inhibitors in Neurotoxic Snake Envenomation1. Patients with clear, objective evidence of neurotoxicity after snakebite e.g., ptosis or inability to maintain upward gaze should receive a trial of edrophonium if available or neostigmine.a. Pretreat with atropine: 0.6 mg IV children, 0.02 mgkg; minimum of 0.1 mgb. Follow with:Edrophonium: 10 mg IV children, 0.25 mgkg orNeostigmine: 1.5-2.0 mg IM children, 0.025-0.08 mgkg2. If objective improvement is evident at 5 min, continue neostigmine at a dose of 0.5 mg children, 0.01 mgkg every 30 min as needed, with continued administration of atropine by continuous infusion of 0.6 mg over 8 h children, 0.02 mg kg over 8 h.3. Maintain vigilance regarding aspiration risk, and secure the airway with endotracheal intubation as needed.REIDS CRITERIA FOR ADMINISTRATION OF ASV Leukocytosis 13,000-15,000cu mm Thrombocytopenia 80,000cu mm Renal failure DIC Soft tissue swelling involving or crossing joint nearby site of bite Systemic symptomssigns of neuroparalytic bite vomiting, abdominal pain, giddiness, ptosis, etc.Dose of ASVLimb Area InvolvementDose 13 of Limb area50 ml13-12 Limb area100 ml50 of Limb area150-200 mlASV should be given within 2 days preferably can be given upto 5-7 days.Comparison of Antivenoms Recently Available for Treatment of Pit Viper Bites in the U Antivenin Crotalidae PolyvalentCroFabAvailable since19542000OriginEquineOvineSnakes used in manufactureCrotalus adamanteusC. adamanteus C. atroxC. atrox C. durissus terrificusC. scutulatus Bothrops atroxAgkistrodon piscivorusContainsSkin testing recommended byIgG, equine albuminFab fragmentsmanufacturerYesNoPretreatment with antihistaminesYesNoDry bite-doseNoneNoneMild - dose0 or 5 vials4 vialsModerate - dose10 vials4-6 vialsSevere - dose15-20 vials6 vialsRepeat dosingAs neededRepeat starting dose if patient fails to stabilize.After stabilization, give 2 vials q6h for 3 more doses. Alternatively, re-dose on an as needed basis with close observation for recurrence of abnormalities.Volume of diluent1000 mL250 mLAdminister over2 h1 hIncidence of anaphyiacticoid reacn23-5614incidence of delayed serum sickness18-863 