Severe arrhythmias may require the use of a temporary pacemaker to ensure adequate cardiac output and to prevent cardiac arrest. In addition the venom has been shown to impair platelet function and decrease serum fibrinogen levels. The patient should be monitored closely and blood products including whole blood, packed RBC's, platelets, cryoprecipitate, and fresh frozen plasma should be given when indicated. The hemorrhagic activity of the venom may result in pulmonary edema, tachypnea, and dyspnea. Neurological symptoms are uncommon with Rhinoceros Horned Viper bites.
Respiratory distress is nearly always secondary to pulmonary edema rather than muscle paralysis.
It is important to keep venom neutralization current and continuous. The best method to accomplish this is to monitor the patient's status. If the present condition does not improve, or should it worsen for any reason, additional antivenom should be administered. Give all additional antivenom in one vial increments. Dilute the antivenom in Lactated Ringers as before and administer the antivenom I.V. piggyback over approximately 15 minutes.