Antivenin Therapy Research Articles

Spider Bite Envenomation in Al Baha Region, Saudi Arabia

The purpose of this study was to highlight the clinical features of spider bite envenomation, a subject which has not, to our knowledge, been previously published in Saudi Arabia. Ten patients (8 males and 2 females) aged between 13 and 75 years (mean 36.8) were hospitalized at King Fahad Hospital, Al Baha, with the diagnosis of spider bites during the 9-year period from June 1988 to May 1997. One of the patients was bitten on the right hand by a brown spider, causing severe cellulitis and tissue necrosis, and requiring surgical debridement and pedicle skin flap graft. The nine other patients (90%) had bites from black spiders identified as black widow spiders. Two of the nine (22.2%) suffered only local reactions in the form of pain, erythema and swelling at the site of bite. The remaining seven (77.8%), had varying symptoms of systemic envenomation, including pulmonary edema, myocardial dysfunction with elevated creatinine kinase, electrocardiographic and echocardiographic abnormalities, progressive paresthesia, generalized body ache, etc. Therapy included analgesics, muscle relaxants, intravenous infusion of calcium gluconate and oxygen where indicated. Specific antivenin therapy was available for only four of the nine patients (44%) with black widow spider bite. Antivenin therapy still produced dramatic relief of the symptoms in the patient with pulmonary edema, even after a delay of 30 hours. Spider bite envenomation should be considered in the differential diagnosis of acute surgical abdomen and myocardial infarction.

Conservative treatment of copperhead snakebites without antivenin.

Polyvalent antivenin remains the most recommended treatment of crotalid envenomation, including copperhead snakebites. Because of the significant morbidity associated with antivenin therapy, some have proposed conservative therapy for less serious envenomations. Few if any studies have separated the treatment of the less serious copperhead bite from the more serious bite of a rattlesnake or a water moccasin. Fifty-five patients, including 12 children, with copperhead bites were treated over a 12-year period. All 55 patients were successfully treated conservatively without antivenin. Conservative treatment resulted in no deaths, limb loss, or residual disability. The mean hospital stay was 2.15 days compared with 3.9 days in patients with systemic symptoms. These data support a conservative approach to most copperhead envenomations and suggest that the treatment for copperhead bites should be segregated from the more serious rattlesnake and water moccasin snakebites.

Anesthetic Implication of Snake-Bite Envenomation

Anesthetic Implication of Snake-Bite Envenomation

Emergency Management of Poisonous Snakebites.

In brief Though 42 snake species in the United States can inflict a poisonous bite, management is the same for 99% of bites because 99% of bites are inflicted by pit vipers. First aid instructions stressing rapid transit to a hospital apply to all bites. Surgical intervention has no place in acute snakebite treatment. Antivenin therapy is appropriate except in cases of mild pit viper envenomation. Pit viper antivenin is the right choice for any pit viper envenomation, and the patient history will guide the choice of coral snake antivenin. For any antivenin administration, care must be taken to prevent allergic reactions. Basic supportive care involves pain control, correcting metabolic and hematologic complications, keeping the patient comfortable, and preventing serum sickness.

When a snake bites

Primary care physicians may be required to treat snake-bitten patients and must differentiate between venomous and nonvenomous snakes. The chief distinguishing characteristics of venomous snakes are fangs and a single row of subcaudal anal plates. The physiologic effects of snake venom are on the cardiovascular, hematologic, and neurovascular systems. The snake-bitten patient first needs supportive treatment and stabilization. Then, the physician must establish whether envenomation has occurred, grade it, and monitor edema around the bite. Local treatment, broad-spectrum antibiotics, and tetanus prophylaxis should be used for all envenomation grades. The decision to administer antivenin therapy should be made on clinical grounds and the envenomation grade. Its use, however, can lead to anaphylaxis and anticomplement reactions.

Treatment of snakebite poisoning

The epidemiology, mechanics, prevention, pharmacology, clinical manifestations, and treatment of snakebites are reviewed. Poisonous snakes bite approximately 8000 persons annually in the United States, causing approximately 12-15 deaths per year. Pit vipers (rattlesnakes, copperheads, cottonmouths, and massasaugas) are responsible for 99% of all snakebite poisonings; coral snakes and other foreign exotic species are responsible for the additional 1%. Envenomation is characterized by pain, edema, and ecchymoses at or near the site of venom injection, followed by cardiac, hematologic, neurologic, renal, and pulmonary toxicity. The major clinical finding in most snakebite poisonings is local tissue necrosis. Immediate treatment for snakebite includes limiting movement and placing a constriction band proximal to the site of venom injection. If medical care is more than 30 minutes away, the wound may be incised and suctioned. Antivenin therapy is the mainstay of medical treatment of snakebite, along with administration of plasma expanders, pain medication, diazepam, tetanus toxoid, antiseptics, and antibiotics. Patients who have pain, swelling, ecchymoses, systemic symptoms, or abnormal laboratory findings within 30 minutes to one hour of a bite are probable candidates to receive antivenin therapy. Before receiving antivenin therapy, the patient must be tested for hypersensitivity to the antivenin. Antivenin therapy is most effective when given within four hours of the snakebite. Pharmacists--especially those serving rural areas--should be familiar with current snakebite treatments, both local and systemic, and should be prepared to provide important information and dispel any myths about snakebite poisoning.

Preliminary observations on the effects of hyperbaric oxygen therapy on western diamondback rattlesnake (Crotalus atrox) venom poisoning in the rabbit model.

Intermittent hyperbaric oxygen therapy has been shown to reduce skeletal muscle necrosis in a compartment syndrome animal model. To study whether intermittent exposure to hyperbaric oxygen augments antivenin therapy in reducing muscle necrosis, we injected sublethal doses of Western Diamondback rattlesnake (Crotalus atrox) venom intramuscularly into the hind legs of New Zealand White rabbits. In this pilot study, the animals were divided into three treatment groups. The first group received one vial of antivenin intravenously, the second group received one vial of antivenin intravenously plus three hyperbaric oxygen treatments, and the third group received no treatments. There were no statistically significant differences among the groups. These preliminary observations suggest that muscle necrosis secondary to Crotalus atrox venom poisoning is not significantly altered either by Antivenin [Crotalidae] Polyvalent at the dose level we used or in combination with intermittent hyperbaric oxygen treatments in this rabbit model.

Complications of crotalidae antivenin therapy

Complications of crotalidae antivenin therapy

Clinical and laboratory features of South American rattlesnake ( Crotalus durissus terrificus) envenomation in children

The venom of the South American rattlesnake Crotalus durissus terrificus was first reported to have mainly haemolytic and neurotoxic physiopathological activities. Later studies demonstrated the systemic myotoxic action of the venom, characterized by the release of myoglobin from damaged skeletal muscle into serum and urine, and a recent report ruled out the presence of intravascular haemolysis in 3 patients, one child and 2 adults. The present paper describes the clinical-laboratory evolution of 10 children bitten by C. durissus terrificus; 2 developed acute renal failure and one died. The myotoxic activity of the venom was evaluated by measuring serum lactic dehydrogenase, creatine kinase and aspartate aminotransferase, by detection of myoglobin in serum and urine, and by muscle biopsy. Haemolytic activity was evaluated by serial measurements of serum haemoglobin and haptoglobin and by detection of urine haemoglobin. We conclude that the signs and symptoms exhibited by patients bitten by C. durissus terrificus are due only to the myotoxic and neurotoxic action of the venom. The only patients with major morbidity were those who initially received subcutaneous antivenin and did not receive definitive antivenin therapy until later.

Crotalidae envenomation.

We treated 18 patients who had Crotalidae envenomation between January 1980 and September 1984. Primary antivenin therapy minimized morbidity and obviated mortality. More specificially, judicious though quantitatively sufficient antivenin therapy made surgical intervention unnecessary. We review the literature on Crotalidae anatomy, venom toxicology, and the envenomation syndrome.

Snake Venom Poisoning

It has been said that everyone knows how to build a fire, run a hotel, and coach a football team; treat could probably be added to that list. Everyone thinks he has the right answer. Those favoring surgical treatment view antivenin use as heretical at best, while proponents of antivenin use seem to believe that surgeons are remnants of an era that recommended bloodletting and other procedures now considered bizarre. As a recent convert to antivenin therapy for snakebite, I anxiously read Russell's new book on the treatment of snake venom poisoning. He has attempted to write a general reference and treatment guide for physicians treating snakebite, and I believe that he has done a good job in fulfilling this goal. Those merely seeking the true path for treatment of snakebite will find a large portion of the book's 500+ pages to be devoted to basic zoology and toxicology.

Antivenin therapy in the emergency department

Venomous animal injuries constitute a significant medical problem worldwide. It is estimated that 40,000 people die annually from venomous snakebite alone. The total morbidity and mortality due to venomous reptiles, arthropods, and marine animals is unknown. The majority of venomous injuries are found in developing countries where the combination of rural populations, high density venomous animal species, and inadequate medical facilities generate a serious public health problem. While venomous animal injuries are less of a problem in the United States, when they do occur they may become a difficult problem to manage and often a major life threat.‘-” Emergency medicine physicians are likely to be involved wth the diagnosis and management of a venomous injury because of their position at the vanguard of the medical system. As in many other emergent conditions, the initial therapy is extremely important and will influence the final outcome of the envenomation. The definitive treatment of envenomation injuries, especially those due to snakebite, is antivenin

Bites and stings of uncommon arthropods. 2. Reduviids, fire ants, puss caterpillars, and scorpions.

Arthropod bites and stings may cause intense pain, sometimes out of proportion to the size of the lesion. Severe reactions may arise from prior exposure and buildup of antibodies. Diagnosis often can be made from the clinical presentation if the physician is familiar with the effects of the uncommon bites and stings. Some uncommon bites, such as those of reduviids, can be treated symptomatically, but others, such as those of poisonous scorpions, call for antivenin therapy.

Poisonous Snakebite Treatment in the United States

This is retrospective report of 107 cases of poisonous snakebites treated in south Georgia and north Florida. Sixty-seven percent of the cases required intensive treatment. Intravenous antivenin therapy, if indicated, should be given early and over a short time. Steroids are of use primarily for allergic phenomena. Fasciotomies were not necessary unless cooling or inadequate antivenin had been administered. A grading system that matches the species of snake with the severity of the bite was used to classify the cases.

Clinical importance of prothrombin time determination in snake-venom poisoning.

Abstract A study of the prothrombin time of patients bitten by Bothrops snakes, principally Bothrops atrox, the fer-de-lance, was undertaken for possible use as a guide to the severity of envenomation and the effectiveness of antivenin medication. Twenty-six cases of snake-bite poisoning, in which prothrombin-time determinations (Quick) were made every 8 hours, were studied. The patients represented two groups: 1) 20 who had been bitten by a snake 8 to 10 hours before admission, some of whom had already received one or two ampules of antivenin, and 2) six patients seen within 3 hours of the bite. The patients received antivenin every 6 to 8 hours. In the first group, the prothrombin time was 5% of normal on admission and reached a peak of 80% at about 40 hours. In the second group, the prothrombin time was 20% of normal on admission, dropped within 8 hours to less than 5% despite intensive antivenin therapy, and then followed the pattern of the larger group. Clinical improvement paralleled the return of prothrombin time to normal. In none of the patients studied did gangrene requiring surgical treatment develop.

Current status of treatment of poisonous snake-bite. Review of recent literature and report of 11 cases.

Proper treatment of poisonous snakebite can reduce the mortality rate to less than 5 per cent. Eleven cases of snakebite treated over the past few years are reported. Methods of treatment are reviewed, emphasizing the use of polyvalent antivenin and supportive therapy. It is felt that early, adequate use of antivenin and immobilization of the patient will suffice in most cases. Other mechanical measures, however, should not be neglected if they appear to offer a better chance of survival. Continued supportive care is stressed.