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At least 289 records · Page 16Linked to original sources
PubMed2002

Crotalidae polyvalent immune Fab (ovine) antivenom is efficacious for envenomations by Southern Pacific rattlesnakes (Crotalus helleri).

STUDY OBJECTIVE: Southern Pacific rattlesnake (Crotalus helleri ) venom is not 1 of the 4 venoms used to produce Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV). There is currently no published clinical experience regarding the efficacy of this new antivenom for confirmed C helleri envenomation, and animal data suggest greatly diminished efficacy. We assessed the efficacy of FabAV for patients with confirmed C helleri envenomation. METHODS: We conducted a prospective observational study of 23 consecutive rattlesnake envenomations that were treated with FabAV at our center. Patients were excluded if the species of snake could not be confirmed, if FabAV antivenom was not given, or if Antivenin (Crotalidae) polyvalent (equine) was given. We collected serial physical examination and laboratory data over a 24-hour period to serially evaluate the severity score and performed follow-up to evaluate delayed reactions. RESULTS: There were 15 patients who received FabAV and had the species of rattlesnake confirmed (9 C helleri, 4 C scutulatus scutulatus, 1 C mitchellii pyrrhus, 1 C ruber ruber ). C helleri envenomations demonstrated similar improvement in serial snakebite severity scores to those of other species. Three patients treated with scheduled dosing had recurrence of progressive swelling (2 C helleri and 1 C mitchellii pyrrhus ) during the 24-hour study period. CONCLUSION: We observed similar improvement in FabAV-treated patients with C helleri envenomation compared with those of other species and conclude that this treatment in standard doses appears efficacious for bites by this species. Progressive swelling may recur despite scheduled dosing.

Animals↗
PubMed2003

Australian tiger snake (Notechis scutatus) and mexican coral snake (Micruris species) antivenoms prevent death from United States coral snake (Micrurus fulvius fulvius) venom in a mouse model.

BACKGROUND: Wyeth-Ayerst has discontinued production of Antivenin (Micrurus fulvius). Currently, there is no other approved coral snake antivenom available in the United States. METHODS: This study was a randomized, placebo-controlled and blinded determination of the ability of a Mexican Micrurus (coral snake) antivenom and an Australian Notechis (tiger snake) antivenom to prevent lethality from a United States Micrurus fulvius fulvius venom in a mouse model. Venom dosing was based on an LD50 determined for this experiment. Our comparison groups included: (1) M. f. fulvius venom + Micrurus antivenom, (2) M. f. fulvius venom + Notechis antivenom, (3) M. f. fulvius venom + protein control, (4) 0.9% normal saline + protein control, (5) saline + Notechis antivenom, (6) saline + Micrurus antivenom. Venom dose was 5 times the determined LD50. The antivenom amounts were capable of neutralizing 10 times the venom injected (50 times the LD50). RESULTS: The LD50 of M. f. fulvius venom was determined to be 0.85 mg/kg. All mice in both antivenom test groups were protected from lethality for the entire 24-hour observation period. Six of the 7 mice in the venom test group died, with a survival time of 349 +/- 382 minutes (mean +/- s.d.) after the venom injection. All three groups of control mice survived the entire 24-hour observation period. CONCLUSIONS: Mexican Micrurus antivenom and Australian Notechis antivenom provide protection from lethality in mice envenomated with a United States M. f. filvius venom.

Animals↗
PubMed1991

Acute anuric renal failure after pigmy rattlesnake bite.

Acute renal failure has been known to follow viper bites in up to 30% of patients, but we believe we have reported the first case in which anuric renal failure developed after the bite of a pigmy rattlesnake. Our patient's renal failure is thought to have been due to a combination of rhabdomyolysis and intrarenal thrombosis caused by DIC. Prompt surgical debridement should be offered to the victim of a bite by any poisonous snake, and antivenin should be administered to any patient with signs of systemic envenomation, with close monitoring for signs of allergic reactions.

Acute Kidney Injury↗
PubMed1994

Snake venom poisoning in the United States: a review of therapeutic practice.

Snake venom poisoning constitutes a medical emergency. It is a complex type of poisoning that not only affects the local bite site but may involve multiple organ systems as well. In the United States, poisonous snakes account for approximately 8,000 bites annually, resulting in about 9 to 15 fatalities. The majority of deaths occur in children, the elderly, and untreated or mistreated individuals. Pit vipers account for almost all bites. Diagnosis and treatment are based on clinical signs and symptoms of envenomation along with identification of the snake. First aid treatment should focus on transporting the victim to the nearest medical facility as soon as possible. Previously advocated first aid measures such as tourniquet, incision and suction, cryotherapy, and electric shock should be avoided. The mainstay of treatment for envenomation is the prompt administration of sufficient quantities of the appropriate antivenin.

Adult↗
PubMed1999

Survey of the stocking of poison antidotes in Alabama hospitals.

BACKGROUND: We wanted to estimate the current antidote supply in Alabama hospitals, establish if certain antidotes were stocked more than others, and identify certain parameters (eg, treatment level of care, licensed bed size, or county population) as predictors for the current antidote supply. METHODS: We faxed surveys to treatment level I/II hospitals and a random sample of treatment level III hospitals. Antidote supply was reported for digoxin immune Fab, pyridoxine, ethanol, pralidoxime, antivenin (Crotalidae), deferoxamine, cyanide, naloxone, and fomepizole. RESULTS: Of treatment level I/II and level III hospitals surveyed, 28 (100%) and 20 (71.4%) responded, respectively. None (0%) of the hospitals surveyed had adequate stocking for all nine antidotes. The results illustrate the common practice of understocking poison antidotes. CONCLUSIONS: Hospitals must reevaluate their current antidote inventories for meeting the needs of acutely poisoned patients. Policy containing specific guidelines must be developed and uniformly adopted as standard of practice.

Alabama↗
PubMed1980

Sites of action of Mojave toxin isolated from the venom of the Mojave rattlesnake.

1 Mojave toxin isolated from the venom of the Mojave rattlesnake (Crotalus scutulatus scutulatus) produced an irreversible blockade of the contractile response of the mouse hemidiaphragm to stimulation of the phrenic nerve in vitro, at concentrations of 0.16 to 20 mug/ml; the response to direct stimulation was not affected over a testing period of several hours.2 Mojave toxin (1 to 4 mug/g) was injected into the tail vein of mice and the intoxicated hemidiaphragm preparation was removed either for testing the contractile response or for intracellular recording.3 In fully intoxicated hemidiaphragms the contractile response to indirect stimulation was either small and transient or absent, whilst the response to direct stimulation was well maintained.4 Intracellular recording showed that resting membrane potentials of the muscle fibres were within the normal range. Endplates were difficult to locate but miniature endplate potentials (m.e.p.ps) were recorded at sites at which neurally evoked responses either could not be detected or did not exceed 2 mV which corresponds to transmitter release of a few quanta only.5 The mean frequency of m.e.p.ps at fully intoxicated endplates was not significantly different from controls but potassium depolarization produced only a small increase in m.e.p.p. frequency relative to the control response. A 50 Hz tetanus had no effect on m.e.p.p. frequency.6 When a sub-lethal dose (3 mug) of Mojave toxin was injected into one hindlimb of mice and the tissues examined at 72 h, there was histological evidence of myonecrosis.7 The isolated perfused heart of the rat was exposed to recycled Mojave toxin (50 and 100 mug/ml) but showed no change in rate or force of ventricular contraction.8 Post-mortem examination of intoxicated mice showed a frequent incidence of localized areas of interstitial and intra-alveolar haemorrhage in the lungs. Other organs including skin and muscle were not affected.9 Mojave toxin showed antigenic similarities to crotoxin, the lethal neurotoxin in the venom of the South American rattlesnake, as determined by the ability of antiserum raised against crotoxin to neutralize Mojave toxin.10 With systemic Mojave intoxication of rapid onset, the cause of death was respiratory paralysis. However, the toxin acts at multiple sites at differing rates of action. With a slower rate of intoxication, impaired respiration may act synergistically with cardiovascular changes to produce circulatory failure. The desirability of using an antivenin with a high titre against Mojave toxin is indicated.

Animals↗
PubMed2002

Crotaline Fab antivenom for the treatment of children with rattlesnake envenomation.

OBJECTIVE: There is little data regarding safety or efficacy of Crotalinae polyvalent immune Fab (ovine) antivenom (crotaline Fab) in pediatric patients. Our objective was to provide the first information regarding safety and effectiveness of this new drug in children. METHODS: Data were collected prospectively and retrospectively for all consecutive pediatric patients bitten by rattlesnakes and treated at 2 urban hospitals during 2001. Cases were included if there were signs of envenomation at presentation, patient age was 13 years or less, and there was administration of crotaline Fab. Cases were excluded if antivenin (Crotalidae) polyvalent (equine origin, the conventional antivenom) was given. Primary outcome variables were snakebite severity scores throughout the course of therapy, number of vials of crotaline Fab administered, occurrence of allergic reactions, adjunct surgical therapy, and the presence of permanent sequelae or serum sickness identified at follow-up. RESULTS: In the 12 cases studied, ages ranged from 14 months to 13 years (mean: 6.9; standard deviation: 4.2). Presentation snakebite severity scores ranged from 2 to 9 (mean: 5.3; standard deviation: 2.3). Total crotaline Fab doses ranged from 4 to 22 vials (mean: 12.7; standard deviation: 5.4). Initial control of symptoms was achieved with 4 to 16 vials (mean: 7.7; standard deviation: 3.7), and severity scores stabilized or improved within 24 hours in all patients. Recurrence of local swelling occurred in 1 case despite scheduled repeat doses of antivenom. No cases required surgical intervention, and no permanent sequelae were identified. No immediate or delayed hypersensitivity reactions occurred. CONCLUSION: In this group of pediatric patients treated for rattlesnake envenomation, crotaline Fab antivenom was safe and seemed to be effective.

Adolescent↗
PubMed1995

Cobras.

Human encounters with cobras in Africa and Asia are common with substantial mortality and primarily respiratory paralysis in untreated cases. First aid includes maintaining calm, placing a lymphatic retardant on the bitten extremity, and transportation to a medical facility. Medical management is antivenin. Physiologic monitoring and the ability to manage the compromised airway are important.

Adult↗
PubMed1996

Biology and treatment of the mamba snakebite.

Mambas are venomous African snakes that are capable of inflicting fatal envenomation. The mambas (genus Dendrosaspis) are members of the family Elapidae [1]. Four species of mamba inhabit equatorial and southern Africa. Without medical treatment, mamba bites are frequently fatal. First aid treatment includes lymphatic retardation with immobilization and pressure wrap. Medical management requires the intravenous administration of mamba-specific antivenin.

Adult↗
PubMed1999

Mojave rattlesnake (Crotalus scutulatus scutulatus) identification.

Mojave rattlesnake (Crotalus scutulatus scutulatus) identification has important diagnostic and therapeutic implications. Envenomation by certain populations of Mojave rattlesnakes may cause a different clinical presentation than that caused by other rattlesnakes. Specifically, Mojave rattlesnake envenomation may cause fewer local effects and more neurologic effects (including respiratory difficulty) than are typically seen after bites from other types of rattlesnake. Thus, it is useful for clinicians to distinguish the Mojave rattlesnake from other rattlesnakes in order to prevent underestimation of severe envenomation because of the lack of local tissue injury. Patients suspected to have been bitten by Mojave rattlesnakes may need more aggressive treatment with antivenin as well as more intensive supportive care. In addition, patients suspected to have been bitten by Mojave rattlesnakes should be closely monitored for an extended observation period, as venom effects may be delayed or prolonged. Mojave rattlesnakes may be particularly difficult to distinguish from Western Diamondback rattlesnakes (Crotalus atrox) because of their similarity in appearance and overlapping ranges. The purpose of this report is to provide clinicians with key characteristics which may assist in distinguishing Mojave rattlesnakes from Western Diamondback and other rattlesnakes.

Animals↗
PubMed1999

Envenomation by the scorpion (Centruroides limbatus) outside its natural range and recognition of medically important scorpions.

A 67-year-old woman presented to a community emergency department in Orange County, CA, after she was stung by a scorpion identified as Centruroides limbatus from Central America. She developed local pain and systemic symptoms, including parasthesias, flushing, hypertension, and wheezing. Envenomation by this genus of scorpion has not previously been reported in Orange County. Scorpions have been reported to be accidentally transported to areas where they are not indigenous, and patients may present anywhere with envenomation by dangerous scorpion species. Physicians should recognize general identifying characteristics of dangerous scorpions and serious signs of envenomation. Almost all dangerous genera of scorpions (including Centruroides sp.) are in the family Buthidae, which can be identified by a triangular sternal plate. Severe systemic signs of envenomation by Centruroides sp. may include respiratory difficulty, somatic neuromuscular dysfunction, and cranial nerve dysfunction. Patients stung by dangerous scorpions may require airway support, extended observation, antivenin, and avoidance of respiratory depressive medications.

Aged↗
PubMed2001

Snakebite envenomation in children: a 10-year retrospective review.

OBJECTIVE: To describe the epidemiology, short-term outcomes, and clinical characteristics of rattlesnake bites (RSB) in children. METHODS: This was a 10-year retrospective chart review of all patients who were <13 years old admitted to a medical toxicology referral service in a major metropolitan area of the southwestern United States with a diagnosis of RSB. RESULTS: Sixty-six children (mean age, 6.33 years) presented to or were transferred to our center with a diagnosis of RSB. Sixty-three percent were male, and the majority of bites (71.93%) occurred on the lower extremities. Forty-nine children (85.96%) developed coagulopathies, and 50 children (87.72%) received Antivenin (Crotalidae) Polyvalent (ACP) administration. Of the 50 children receiving ACP, 19 developed an immediate hypersensitivity reaction. Five cases of morbidity resulted, but no deaths were recorded. CONCLUSIONS: Serious morbidity is infrequent in children following RSB.

Adolescent↗
PubMed2003

Regional vs systemic antivenom administration in the treatment of snake venom poisoning in a rabbit model: a pilot study.

OBJECTIVE: To develop a model that compares 2 different routes of antivenom administration (standard intravenous [IV] administration vs regional administration below a tourniquet) to assess their ability to limit muscle necrosis in a rabbit model of rattlesnake venom poisoning. METHODS: New Zealand white rabbits were randomly assigned to 4 groups. All animals underwent general anesthesia and were then injected intramuscularly (IM) with a sublethal dose of western diamond-back rattlesnake (Crotalus atrox) venom in the right thigh and a similar volume of normal saline (NS) control in the left thigh. Thirty minutes later, standard treatment group animals (n = 4) received 1 vial of reconstituted Antivenin (Crotalidae) Polyvalent (ACP) and 10 mL of NS through an ear vein. Experimental treatment group animals (n = 4) had their lower extremities exsanguinated and isolated by arterial tourniquets. One vial of ACP was then given through a distal IV in the envenomed extremity, and 10 mL of NS was given through an IV in the sham extremity. Tourniquets were removed 30 minutes later. Positive control group animals (n = 2) similarly had their lower extremities exsanguinated and isolated by tourniquets. They then received 10 mL of NS through distal IVs in each lower extremity. Tourniquets were again removed after 30 minutes. Negative control group animals (n = 2) received 2 doses of NS only (10 mL each) through an ear vein. Serum creatinine phosphokinase (CPK) levels were drawn at baseline and 48 hours following venom injection. At 48 hours, the animals were injected with technetium pyrophosphate. Two hours later, they were euthanized, and the lower extremities were scanned to determine levels of radionucleotide uptake in envenomed muscles compared to contralateral sham-injected muscles. The anterior thigh muscle groups were then removed, fixed, stained, sectioned, and analyzed in a blinded fashion by a veterinary pathologist for muscle necrosis grading. RESULTS: There was no evidence of statistically significant differences in changes in serum CPK levels (from baseline to 48 hours), technetium pyrophosphate uptake ratios (right leg/left leg), or muscle necrosis indices in any 2-group analysis. CONCLUSIONS: Results of this pilot study do not suggest any beneficial effect of ACP, in the dose and routes used, in limiting local muscle necrosis following IM rattlesnake venom poisoning in the rabbit model.

Animals↗
PubMed1997

Clinical applications of commonly used contemporary antidotes. A US perspective.

Poisonings are a common problem. In 1995, over 2 million exposures were reported to American poison information centres alone. The majority of poisoning exposures can be treated without major therapeutic intervention. If therapy is indicated, it is usually in the form of gastrointestinal decontamination with activated charcoal, to prevent absorption of the toxin and the subsequent toxicity that may occur. In a limited number of cases, more aggressive life-support measures may be necessary to treat the adverse effects of poisons. Occasionally, that intervention may include the use of pharmacological antagonists, more commonly referred to as antidotes. According to the American Association of Poison Control Centers, the most commonly used antidotes are acetylcysteine, naloxone, atropine, deferoxamine (desferrioxamine) and antivenins. Overall, 17 antidotes account for 99% of all antidote use and those agents are reviewed in this article. With the exception of naloxone, most antidotes have pharmacological effects that are independent of their inherent antidotal properties. Therefore, antidotes should be used judiciously because their pharmacological properties may exacerbate pre-existing toxicity and only in rare circumstances are they used prophylactically. Some antidotes, such as digoxin-specific antigen binding fragments (digoxin immune Fab), are very expensive, and both the risk: benefit ratio and the associated cost should be considered before the antidote is administered. The principle aims are to "treat the patient, not the poison' and to do no harm to the patient. Antidotes should be used only when they are indicated and may help a patient.

Acetylcysteine↗
PubMed1985

Unusual neurological symptoms in a case of severe crotalid envenomation.

In Sweden bites by non-European venomous snakes are reported to the Poison Information Centre 5-10 times annually. These incidents generally take place in private homes and may result in severe poisoning. We report a recent case of envenomation from a bite by Crotalus durissus terrificus with a prolonged, atypical course. The patient, a 24-year old man, was admitted to hospital approximately eight hours after the snakebite. On admission we noted coma, circulatory failure, hypofibrinogenaemia with bleeding from fang marks on his right arm, melaena and haematemesis. Antishock therapy including intravenous fluids, steroids and epinephrine was instituted immediately and within six hours infusion of polyvalent antivenom was started. Next day, when the initial disturbances were corrected, peripheral neurological features were noted and the patient gradually became comatose. Antivenin therapy was reinstituted. The coma lasted for one week and recovery extended over several months with persisting neurological symptoms. Six months after the bite there were still pathological findings in the electromyogram.

Adult↗
PubMed1986

Fatal rattlesnake envenomation in Arizona: 1969-1984.

Case histories of the last nine fatalities (1969-1984), in which the cause of death on the State of Arizona Certificate of Death was snakebite, were reviewed. Six males and three females ranged in age from 2 to 77 years, and were bitten between 0800-2100 hours from April to September. Bites in three adult males were "illegitimate" and of these, two were by captive Mojave rattlesnakes, Crotalus s. scutulatus. The latter two victims had been bitten previously and remained at home, refusing treatment. In the other seven victims, the snakes involved were not identified. However, all localities where bites occurred were within the geographical and altitudinal range for Crotalus atrox and C. s. scutulatus. The apparent cause of death was prolonged hypotension with major organ system failure in five, intestinal hemorrhage in one, and was unknown in three. Major organs were involved as follows: cardiac failure (two); noncardiac pulmonary edema (two); renal failure (two); unconsciousness with airway obstruction and brain damage (two); and coagulopathy with multiple hemorrhage sites (one). Seven of the nine deaths appeared to be preventable. Four delayed going to a medical facility and six did not have hypotension corrected. Antivenin was not administered early (first four hours) or in adequate amounts (10 vials or more) because of delayed arrival in five or physician's decision in four. Pre-existing cardiac disease contributed to death of two victims. Rattlesnake bite victims should not delay travel to a medical facility and hypotension must be treated aggressively and appropriately.

Adult↗
PubMed1998

Intravascular hemolysis associated with North American crotalid envenomation.

CASE REPORT: This is a case of severe intravascular hemolysis, without significant coagulopathy, following envenomation by a North American crotalid. A MEDLINE search from 1966-1997, and a review of older literature, revealed no similar cases. A 4-year-old girl was envenomated in her right foot by a 2.5 foot-long rattlesnake whose description matched that of the Hopi rattlesnake (Crotalus viridis nuntius). The snake was not captured. Her initial hematocrit was 45%. In spite of treatment with antivenin and improvement in her lower extremity pain and swelling, her hematocrit decreased to 20.4%. Laboratory tests and clinical exam showed a Coombs positive hemolytic anemia without significant signs of coagulopathy.

Anemia, Hemolytic↗
PubMedDate not supplied

Eastern Diamondback Rattlesnake (Crotalus adamanteus) envenomation of dogs: 31 cases (1982-2002).

The medical records of 31 dogs treated for envenomation by the Eastern Diamondback Rattlesnake (Crotalus adamanteus) were reviewed. Twenty-four of 25 dogs that survived were hospitalized for an average of 4.3 days. The most common presenting signs were tachycardia, swelling/edema, depressed mentation, tachypnea, and bleeding puncture wounds. Thirteen (42%) of the 31 dogs were presented with or developed cardiac arrhythmias, predominantly ventricular premature contractions. Hematological disorders, including defibrination, elevated fibrin split products, hemolytic anemia, thrombocytopenia, and prolonged clotting times, were recorded in 81% of the dogs. Polyvalent crotalid antivenin was administered (mean of 4.0 vials per dog) to 88% of the surviving dogs and 50% of the nonsurviving dogs.

Animals↗