(Figure ​services.(Figure2)2) Patients who develop no venom effects during the observation period should be discharged with instructions to return promptly if signs of envenomation develop or progress. Figure 2 Factors Influencing Observation Time for Patients with selleck chem Wortmannin Apparent Dry Bites and Initially Minor Envenomations Managed Without Antivenom. Discharge criteria and post-discharge management (boxes 7, 8, and 14) Patients who have had no further progression of venom effects during an appropriate period of observation may be discharged when certain criteria are met. As with

any patient going home from the hospital, the patient must be able to perform activities of Inhibitors,research,lifescience,medical daily living unassisted or with the assistance available in the home, have adequate pain control on oral medications, and have no other outstanding medical issues requiring hospital care. In addition, the Inhibitors,research,lifescience,medical patient should not have any unfavorable trends in protime, fibrinogen levels, or platelet counts, since deterioration

in one or more of these parameters may be an early sign of recurrent or delayed-onset hematologic venom effects. Following discharge, patients should be instructed to maintain limb elevation as much as possible to speed resolution of swelling. Progressive swelling Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical that does not improve with elevation or signs of abnormal bleeding, such as gingival bleeding, easy bruising, or melena, may be the hallmark of recurrent hematologic venom effects, and should lead to prompt re-evaluation. Serum sickness, a

type III hypersensitivity reaction caused by administration of exogenous proteins, is a known complication of antivenom therapy. In under prospective studies, approximately 5 – 10% of patients treated with ovine Fab antivenom develop signs of serum sickness, such as fever, rash, myalgias, and arthralgias [44]. Inhibitors,research,lifescience,medical Serum sickness following Fab antivenom administration is generally mild and responds well to treatment with oral antihistamines Entinostat and corticosteroids. At the time of discharge, patients should be instructed about the symptoms of serum sickness and given directions regarding follow-up care should serum sickness develop. Few data exist to inform the number and timing of follow-up visits. In general, the panel felt that mandatory follow-up visits were not needed for patients who had minimal envenomation and did not require antivenom administration. Similarly, because the risk of late hematologic venom effects is small, routine follow-up of patients with uncomplicated copperhead snake envenomations who did not develop hematologic venom effects during hospitalization is unlikely to provide clinical benefit to a patient.