Antivenom dosing, preparation, and administration recommendations vary by product. Coverage, initial dosing, preparation, and administration of antivenoms are included in this CPG. Each antivenom recommended in the CPG has a rapid reference on dosing and key notes needed in the Regional Sections as well as in Appendix H: Antivenom Dosing by Product. Each antivenom also has a detailed product page with dosing, mixing / administration instructions, and additional information within its respective regional section (Appendices B – E).

Note on Antivenom Infusions versus Direct IV/IO Push:

For most first line antivenoms in this CPG, administration using either a) 100, 250, or 500 mL IV bag of isotonic fluids (0.9% NS ideal; Lactated Ringers is acceptable) with 10-minute IV/IO infusion or b) direct IV push is recommended in order to get a full dose of antivenom onboard as quickly as possible and neutralize venom before further damage has occurred.

However, if this is not possible, it is acceptable to dilute antivenom in any size bag of isotonic solution you have available and give over 10 – 30 minutes.

While the amount of antivenom given should not change based upon the patient’s size, smaller volumes of isotonic fluids may be indicated (especially in pediatric patients) to avoid volume overload or worsening dependent edema of bitten limb.