Snake and scorpion bites
Chris Carter in Critical Care Nursing in Resource Limited Environments, 2019
Epidemiological data in countries with venomous snakes is variable making it difficult to establish the true extent of the problem. From the evidence available the incidence of snake bite envenomation is a global issue and has been re-classified as a Neglected Tropical Disease by the World Health Organization. There are many venomous snakes throughout the world. Snake bites cause skin and soft tissue injuries resulting in scarring. Deeper muscle damage may result in amputation or complex delayed wound healing. In some areas of the world, scorpion stings are more common than snake bites and can be fatal. Twelve types of snakes are responsible for the majority of deaths worldwide. The types of venomous snakes present depend on the geographical location. Around 95% of cases snake envenomation takes place in LICs or LMICs and involve the poorest and those who live in rural communities.
Poisoning
Michael S. Maloney in Death Scene Investigation, 2017
Intentional, unintentional, and adverse reaction poisonings may be difficult to distinguish from one another. Inhaled poisons are poisons in a gaseous, atomized, or aerosol powder form that are breathed in and transmitted through the mucus lining of the respiratory system or through the alveoli. They may be accidentally inhaled in industrial accidents, or they may be used in the intentional exposure in homicide. For an inhaled poison, the investigator should ensure that the scene has been cleared of all toxic fumes prior to entry. Poisons in a solid, semisolid, or liquid form may be ingested, where they are absorbed through the mucus lining of the digestive tract. They may be intentionally ingested, accidentally ingested or intentionally administered. Poisonous spiders, fish, coral, and venomous spiders may all expose the victim to poison through their bite, envenomation, or contact with poisoned barbs.
Poisoning and Envenoming by Animal Neurotoxins in the Tropics
U. K. Misra, J. Kalita, R. A. Shakir in Tropical Neurology, 2003
Envenoming and poisoning by animal toxins is a broad subject with important geographic differences. Many types of envenoming and poisoning have neurological manifestations. 16 For proper diagnosis and correct treatment, the neurologist in tropical countries should be aware of the epidemiology, clinical manifestations and differential diagnosis of different types of envenoming and poisoning. Toxins are the chemical substances with more or less specific actions on biological systems that are present in venoms and poisons. Venoms are mixtures of toxins produced in specialized glands connected with structures such as fangs and stingers designed for inoculation of these substances. Poisons are also mixtures of toxins which are either produced in nonspecialized tissues or accumulated in an organism. Envenoming (or envenomation) is defined as inoculation of venom resulting in clinical or laboratory abnormalities; whereas, poisoning or intoxication is usually a consequence of the ingestion of poisonous animals. 6 A bite or sting of a venomous animal or the ingestion of a poisonous one does not always result in envenoming or poisoning. The amount of injected or ingested toxins is of paramount importance and should be considered before specific treatment is instituted.
Neotropical freshwater stingrays (Chondrichthyes – Potamotrygoninae): biology, general features and envenomation
Published in Toxin Reviews, 2020
Juliana Luiza Varjão Lameiras, Oscar Tadeu Ferreira da Costa, Maria Cristina Dos-Santos
Neotropical stingrays have stingers at the base of the tail, which are used in self-defense and are covered with an epithelium containing mucous and venom glands. The stingray then sinks its stinger into the victim, causing an extremely painful wound, which can result in tissue necrosis. Medical treatment is based on the use of painkillers, anti-inflammatory drugs and antibiotics, as to date there is no specific antidote for this type of envenomation. Public health authorities should therefore plan measures aimed at the treatment and epidemiologic reporting of stingray envenomation so as to encourage, and provide a basis for, the relevant organs to implement measures to raise environmental awareness, train health professionals to treat victims of envenomation and undertake studies to produce specific serum therapies.
Early administration of Fab antivenom resulted in faster limb recovery in copperhead snake envenomation patients
Published in Clinical Toxicology, 2019
Victoria E. Anderson, Charles J. Gerardo, Malin Rapp-Olsson, Sean P. Bush, Michael E. Mullins, Spencer Greene, Eric A. Toschlog, Eugenia Quackenbush, S. Rutherfoord Rose, Richard B. Schwartz, Nathan P. Charlton, Brandon Lewis, Kurt C. Kleinschmidt, Kapil Sharma, Eric J. Lavonas
Background: No previous research has studied whether early snake antivenom administration leads to better clinical outcomes than late antivenom administration in North American pit viper envenomation. Methods: A secondary analysis of data from a clinical trial of Fab antivenom (FabAV) versus placebo for copperhead snake envenomation was conducted. Patients treated before the median time to FabAV administration were classified as receiving early treatment and those treated after the median time were defined as the late treatment group. A Cox proportional hazards model was used to compare time to full recovery on the Patient-Specific Functional Scale (PSFS) instrument between groups. Secondary analyses compared estimated mean PSFS scores using a generalized linear model and the estimated proportion of patients with full recovery at each time point using logistic regression. To evaluate for confounding, the main analysis was repeated using data from placebo-treated subjects. Results: Forty-five subjects were treated with FabAV at a median of 5.47 h after envenomation. Patients in the early treatment group had a significantly shorter time to full recovery than those treated late (median time: 17 versus 28 days, p = .025). Model-estimated PSFS scores were numerically higher at each time point in the early group. No difference was found between patients treated early versus late with placebo. Conclusions: In this secondary analysis of trial data, recovery of limb function was faster when Fab antivenom was administered soon after envenomation, as opposed to late administration.
Monitor lizard bite-induced acute kidney injury – a case report
Published in Renal Failure, 2014
Sanjay Vikrant, Balbir Singh Verma
Envenomations by venomous lizards are rare. Monitor lizard bite-induced acute kidney injury (AKI) is a previously unreported complication in humans. A 55-year-old female was bitten on her right leg during farming activity by a monitor lizard (Varanus bengalensis). The patient experienced severe local pain and bleeding from the wound, coagulopathy, hemolysis, rhabdomyolysis, sepsis, and AKI. Patient was treated with supportive care and peritoneal dialysis but succumbed to a sudden cardiac arrest. Post mortem kidney biopsy revealed pigment induced-acute tubular injury. AKI after monitor lizard envenomation is caused by acute tubular injury in the setting of intravascular hemolysis, rhabdomyolysis and sepsis. Coagulopathy and direct nephrotoxicity may be the other contributory factors in causing AKI.