>> The Centers for Disease Control and Prevention created this video
to guide healthcare professionals on preparing
and administering antitoxin for the treatment of botulism.
Botulism is a paralytic disease caused by botulinum neurotoxin.
Patients generally have symmetric, descending, flaccid paralysis of motor and autonomic nerves.
Paralysis starts in the head and moves down.
People with botulism may have double-vision, drooping eyelids, slurred speech,
difficulty swallowing and dry mouth.
As paralysis progresses, the muscles needed for breathing and moving become weak.
People with botulism are usually alert and aware,
although they may not seem to be because of the paralysis.
Always tell the patient when you are administering a test or treatment.
Botulism is an emergency.
The initial diagnosis is based on clinical signs and symptoms.
Do not wait for laboratory confirmation to obtain a consultation or begin treatment.
If you think a patient might have botulism,
call your state health department's emergency or after-hours number.
CDC provides consultation at the request of state public health officials.
State public health officials can reach CDC 24/7 at 770-488-7100.
If the consultation supports botulism as a likely diagnosis,
the physician can request antitoxin and begin treatment as soon as it arrives.
If the patient is an infant, consult the California Department
of Public Health's Infant Botulism Treatment and Prevention Program at 510-231-7600
or visit infantbotulism.org for guidance.
Botulism antitoxin is made from the plasma of horses.
It has antibodies that neutralize the toxins.
FDA has approved the antitoxin for the treatment of botulism caused
by botulinum neurotoxins Type A, B, C, D, E, F and G in people of all ages.
The antitoxin is a clear, colorless liquid.
If it arrives frozen, you can thaw it in a water bath
at 98.6 degrees Fahrenheit, 37 degrees Celsius.
Do not shake the vial.
Inspect it closely.
If you notice any damage to the seal or vial, discard it and notify the patient care team.
The volume in the vial varies by lot number.
Vials typically contain 10 to 22 milliliters.
Withdraw the entire contents of the vial to measure the volume
so you can accurately calculate the amount needed in the one to 10 dilution.
The dose for adults is one vial.
The dose for children is a percentage of one vial based on weight.
Refer to the package insert to calculate the pediatric dose.
Discard any unused antitoxin because it does not contain a preservative.
Each vial is for a single use.
Add the contents of the syringe to an infusion bag containing the correct amount
of 0.9% normal saline to make a one to 10 dilution of antitoxin to saline.
Do not use any other diluents.
Mix the antitoxin solution with the saline by gently inverting the bag
and returning it to the original position.
Take blood, stool and any other samples
for botulism testing before antitoxin is administered to ensure accurate test results.
Have epinephrine nearby in case of a hypersensitivity reaction.
Patients might be at higher risk of a reaction if they are allergic to horses
or ever received a treatment derived from a horse product, have asthma, or get hay fever.
Remember that patients are typically alert and aware.
Always tell them when you are administering a test or treatment.
Inspect the diluted antitoxin in the IV bag before starting the infusion.
The antitoxin is a clear, colorless liquid.
Do not use if it is discolored, turbid, cloudy,
or contains more than a few small translucent particles.
Botulism antitoxin is recommended only for intravenous use.
Use an IV line with a constant infusion pump and a sterile 15 micron or smaller inline filter.
Do not delay antitoxin administration if a filter is not available.
Administer the diluted antitoxin solution by slow IV infusion,
starting with the recommended rate for the patient's age.
For adults age 17 and older, this is 0.5 milliliters per minute.
For children, it is 0.01 milliliters per kilogram per minute.
Throughout the infusion, observe the patient for adverse reactions and monitor vital signs.
Common adverse reactions include headache, nausea, itching, and hives.
If the infusion is well tolerated, you may increase the infusion rate.
For adults, you may double the rate every 30 minutes
to a maximum of two milliliters per minute.
For children, you may increase the rate
by 0.01 milliliters per kilogram per minute, every 30 minutes, to a maximum
of 0.03 milliliters per kilogram per minute.
Decrease the infusion rate if the patient develops discomfort
or has an infusion-related adverse reaction.
The infusion will take two to seven hours to finish, depending on the patient's age
and how well the infusion is tolerated.
Report any adverse reactions to the Food and Drug Administration at 1-800-332-1088
or FDA.gov/medwatch, or to the manufacturer at 1-800-768-2304.
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