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Snake Envenomation
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
The controversy with snake envenomation is in regard to the use of antivenom, as many question whether they are needed (Gale et al., 2016). Although most snakebites are not venomous, antivenom is readily available and patients as well as health care providers often want it and even demand it. There are approximately 25 snake antivenoms available worldwide, but the main antivenom used and studied in the United States is the sheep antivenom (ovine polyvalent crotalidae immunoglobulin [CroFab] which are antibodies harvested from a sheep injected with small amount of crotalidae venom). Horse serum antivenom has been recently introduced as a competitor. The complications of CroFab antivenom have been well documented and are typical of injecting ovine antibodies. While severe reactions, including strokes and fatalities, have been reported, in general the CroFab antivenom has been reported to be relatively safe (Schaeffer et al., 2012; Kleinschmidt et al., 2018). Since CroFab antivenom is currently used so widely and is almost a standard, ethical concerns have minimized scientific rigors about formulating a recent study to determine the usefulness of CroFab antivenom. Since the earlier randomized multicenter study in 2001 on 31 patients, efficacy studies have been few.
Bites and stings
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
The patient of a snakebite should be kept under observation for a minimum period of 24 hours. Antivenin therapy is very important in the management. Adverse reactions to antivenin are seen in the form of serum sickness or anaphylaxis. Hypersensitivity to antivenin is common in those who have been previously treated. The evaluation of antivenin reactions is complicated, because serum sickness and snakebites share some signs and symptoms. Thrombocytopenia induced by rattlesnake venom (Crotalidae) is only partially reversed by antivenin polyvalent administration. DIC caused by crotalid snakebites can occur even after antivenin treatment. DIC is also seen in envenomation by some exotic vipers. In India, where the cost of antivenin therapy is a critical factor, low-dose regimens have been shown to be an effective alternative. Tourniquets have been associated with tissue ischemia if improperly applied. Tourniquet application appears to be of little benefit according to some studies [59].
Spiders
Published in Gail Miriam Moraru, Jerome Goddard, The Goddard Guide to Arthropods of Medical Importance, Seventh Edition, 2019
Gail Miriam Moraru, Jerome Goddard
Immediate first aid should be administered for bites by any large black spider along the east coast of Australia, but especially in the Sydney area. A pressure bandage can be applied and the bitten limb immobilized using a splint. The spider should be captured, if possible, for identification. At the hospital, patients are carefully monitored for signs and symptoms for 4 hours. Little or no venom may have been injected during the bite. If signs and symptoms occur, such as mouth numbness, tongue spasms, nausea, vomiting, profuse sweating, salivation, and other muscle spasms, administration of antivenom is indicated (per package insert instructions). Patients should be monitored closely for the development of allergic reactions; however, severe allergic reactions to funnel web spider antivenom are uncommon.
Epidemiology of scorpionism in France: nationwide scorpion exposure
Published in Clinical Toxicology, 2021
Jules-Antoine Vaucel, Cédric Gil-Jardine, Magali Labadie, Sébastien Larréché, Camille Paradis, Audrey Nardon, Arnaud Courtois, Jérôme Langrand, Hatem Kallel
Overall, effectiveness of antivenom, prazosin, dobutamine, and benzodiazepines have been reported in the management of scorpion envenoming. Antivenom inhibits the scorpion venom when administered at the early phase after the sting. But its efficiency was not assessed for native French scorpions. However, in case of children envenoming by Tityus spp., the question remains unresolved. Prazosin limits hypertension caused by catecholamine surge following scorpion envenoming. It decreases the mortality and the hospital stay [59]. But it is not authorized in France for this indication. Dobutamine was reported to be an effective treatment in case of respiratory or hemodynamic failure following scorpion sting [60–62]. The optimal dose to start with is 5 to 10 µg/Kg/min [62]. Benzodiazepines can be used in case of cerebro-muscular dysfunction induced by Tityus spp. envenoming and can reduce symptoms duration [18,63].
The effect of myocardial injury on the clinical course of snake envenomation in South Korea
Published in Clinical Toxicology, 2021
J. M. Moon, Y. J. Koo, B. J. Chun, K. H. Park, Y. S. Cho, J. C. Kim, S. D. Lee, Y. R. Min, H. S. Park
Intravenous administration of antivenom is the only specific treatment to counteract envenomation. The criteria for antivenom treatment provided by the World Health Organization (WHO) include local swelling and systemic symptoms defined as shock, hematotoxic or neurotoxic symptoms, rhabdomyolysis, and acute kidney injury but not myocardial injury [13]. In addition, several clinical grading scales for envenomation, including the snakebite severity scale, do not refer to myocardial injury as a domain of envenomation to determine severity and the dosage of administered antivenom [14]. Furthermore, indications for and the optimal dosage of antivenom have not been rigorously defined in Korea [5,15]. Because most studies related to snakebites have focused on the hematotoxic, myotoxic and neurotoxic aspects of envenomation and have not investigated any associated cardiotoxicity, the presence of myocardial injury might be neglected when physicians make decisions about whether to administer antivenom.
Facts and ideas from anywhere
Published in Baylor University Medical Center Proceedings, 2021
Producing antivenom is a long, expensive process, and because most people who need it live in developing countries, such drugs are not big moneymakers. In 2014, Sanofi discontinued production of its antivenom Fav-Afrique, a drug effective against the venom of 10 of Africa’s most dangerous snakes. It discontinued production because the medicine was not profitable. Antivenom production requires actual venom. That comes from labs that may house thousands of snakes in captivity; they are milked about once a month for their venom. Depending on the species, venom can cost a pharmaceutical company up to several thousand dollars a gram, and then the venom—in amounts too small to have deleterious effects—is injected into horses or other large animals whose blood develops antibodies. Blood is drawn, and lab technicians separate out the antibodies and purify them to make antivenoms. Even with a high-quality antivenom, treating snake bites can be hit or miss: the chemical makeup of venom and its effects can vary from snake to snake, even within species. Sometimes antivenoms that are supposed to treat certain species do not work in some areas. The puff adder’s venom can change from one area to another.