It is advisable to check periodic serum and urine analyses during therapy as outlined above. It is always best to keep the patient in an Intensive Care setting until free of major symptoms for 24 hours. The patient should be observed in the hospital for at least 24 hours after the major symptoms abate. As noted above, the variability of symptoms in rattlesnake envenomation can be great. It is important to note the continual progression of symptoms throughout the course of therapy, and give additional antivenom as necessary to titrate these symptoms.
Fluid management is very important in snakebite cases.
The patient should be well hydrated and a brisk urine output maintained. Alcohol should also be avoided. If the patient remains oligoanuric, dialysis should be considered early. Tetanus prophylaxis should be current Antibiotics are NOT recommended prophylactically. Prompt delivery of antivenom following the bite may lessen the extent of local tissue damage, although some evidence suggests that certain antivenoms have less efficacy in ameliorating or protecting against the local action of Bothrops venom.