DTP Box Jellyfish Antivenom

Question 1

Pharmacology of Box jellyfish antivenom

Answer 1

concentrated immunoglobulin acts to neutralise the toxins in the venom

Question 2

Metabolism of Box jellyfish antivenom

Answer 2

In muscle tissue and the liver.

Question 3

Indications for Box jellyfish antivenom

Answer 3

Box jellyfish envenomation associated with any of the following:
– a patient currently in cardiac arrest
– ALOC
– cardiac AND/OR respiratory distress
or collapse
– total surface area affected greater than half
the surface area of one limb
– intractable pain unrelieved by icepacks,
methoxyflurane AND/OR narcotic analgesia.

Question 4

Contraindications for Box jellyfish antivenom

Answer 4

KSAR

Question 5

Precautions for Box jellyfish antivenom

Answer 5

It is a foreign protein, which can cause sensitisation, allergic reaction or anaphylaxis

Question 6

Side effects for Box jellyfish antivenom

Answer 6

• Allergic reaction including anaphylaxis
and delayed serum sickness
• Intense stinging sensation on injection

Question 7

Presentation

Answer 7

Ampoule, 20,000 units/1.5 – 4 mL box jellyfish antivenom

Question 8

Onset (IV) Duration (IV) Half-life (elimination)

Answer 8

Not available

Question 9

Schedule

Answer 9

S4 (Restricted drugs).

Question 10

Adult dose for box jellyfish envenomation

Answer 10

IM 60,000 units
Single dose only.

IV 20,000 units
Slow push over 10 minutes.
Single dose only.

Question 11

What is the Syringe preparation

Answer 11

Mix 20,000 units of antivenom with sodium chloride 0.9% to achieve a final concentration of 20,000
units/20 mL.

Question 12

Adult dose for Box jellyfish envenomation with patient in cardiac arrest

Answer 12

20,000 units
Slow push over 2–5 minutes.
Repeated immediately up to 2 times.
Total maximum dose 60,000 units.

Question 13

Paediatric dose for Box Jellyfish envenomation

Answer 13

IM 60,000 units
Single dose only.

IV 20,000 units
Slow push over 10 minutes.
Single dose only.

Question 14

Paediatric dose for Box jellyfish envenomation with patient in cardiac arrest

Answer 14

IV 20,000 units
Slow push over 2–5 minutes.
Repeated immediately up to 2 times.
Total maximum dose 60,000 units.

Question 15

Speical notes

Answer 15

• The dose of antivenom is related to the dose of venom, not based on the size of the patient.
• IV injection is the preferred route of administration for all indications.
• 60,000 units of antivenom may equate to a volume of up to 12 mL.

Question 16

Administration during cardiac arrest

Answer 16

• If a patient is in cardiac arrest due to box jellyfish
envenomation, box jellyfish antivenom is only to be
administered following the commencement of effective CPR, advanced life support measures and administration of cardioactive drugs.

Question 17

IM administration

Answer 17

For the purpose of IM administration, officers may administer up to 2 mL in each Deltoid muscle and up to 5 mL in each Vastus Lateralis muscle.

Question 18

Anaphylaxis after administration

Answer 18

• At all times during antivenom therapy adrenaline must be available in case of an anaphylactic reaction.
- If reaction occurs, immediately cease the administration of box jellyfish antivenom and treat patient in accordance with the QAS Anaphylaxis and allergy CPG.