Tags

Type your tag names separated by a space and hit enter

Clinical effects of red-bellied black snake (Pseudechis porphyriacus) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP-11).
Med J Aust. 2010 Dec 6-20; 193(11-12):696-700.MJ

Abstract

OBJECTIVE

To describe the clinical features and laboratory findings in patients with definite red-bellied black snake (RBBS; Pseudechis porphyriacus) bites, including correlation with results of venom assays.

DESIGN, PATIENTS AND SETTING

Prospective cohort study of patients with definite RBBS bites, recruited to the Australian Snakebite Project from January 2002 to June 2010.

MAIN OUTCOME MEASURES

Clinical and laboratory features of envenoming; peak venom concentrations and antivenom treatment.

RESULTS

There were 81 definite RBBS bites; systemic envenoming occurred in 57 patients (70%) and local envenoming alone occurred in one patient. Systemic envenoming was characterised by local envenoming in 55 patients (96%), systemic symptoms in 54 patients (95%), anticoagulant coagulopathy with a raised activated partial thromboplastin time (aPTT) in 35 patients (61%) and myotoxicity in seven patients (12%). One patient required non-invasive ventilation for severe myotoxicity that resulted in muscle weakness. Three patients developed local ulceration. There were no deaths. Twenty-two envenomed patients (39%) received tiger snake or black snake antivenom, and administration within 6 hours of the bite was associated with normalisation of the aPTT. Eight patients (36%) had immediate hypersensitivity reactions to antivenom, including one case of anaphylaxis. The median peak venom concentration in 37 systemically envenomed patients with serum available was 19 ng/mL (interquartile range, 12-50 ng/mL; range, 3-360 ng/mL), which did not correlate with clinical severity. In 17 patients who received antivenom and had venom concentration measured, no venom was detected in serum after the first antivenom dose, including nine who were given one vial of tiger snake antivenom.

CONCLUSION

RBBS envenoming caused local effects, systemic symptoms, anticoagulant coagulopathy and, uncommonly, myotoxicity. One vial of tiger snake or black snake antivenom appears to be sufficient to remove venom and neutralise reversible effects, but hypersensitivity reactions occurred in over a third of patients.

Authors+Show Affiliations

Emergency Department, Princess Alexandra Hospital, Brisbane, QLD, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21143062

Citation

Churchman, Andrew, et al. "Clinical Effects of Red-bellied Black Snake (Pseudechis Porphyriacus) Envenoming and Correlation With Venom Concentrations: Australian Snakebite Project (ASP-11)." The Medical Journal of Australia, vol. 193, no. 11-12, 2010, pp. 696-700.
Churchman A, O'Leary MA, Buckley NA, et al. Clinical effects of red-bellied black snake (Pseudechis porphyriacus) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP-11). Med J Aust. 2010;193(11-12):696-700.
Churchman, A., O'Leary, M. A., Buckley, N. A., Page, C. B., Tankel, A., Gavaghan, C., Holdgate, A., Brown, S. G., & Isbister, G. K. (2010). Clinical effects of red-bellied black snake (Pseudechis porphyriacus) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP-11). The Medical Journal of Australia, 193(11-12), 696-700.
Churchman A, et al. Clinical Effects of Red-bellied Black Snake (Pseudechis Porphyriacus) Envenoming and Correlation With Venom Concentrations: Australian Snakebite Project (ASP-11). Med J Aust. 2010;193(11-12):696-700. PubMed PMID: 21143062.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical effects of red-bellied black snake (Pseudechis porphyriacus) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP-11). AU - Churchman,Andrew, AU - O'Leary,Margaret A, AU - Buckley,Nicholas A, AU - Page,Colin B, AU - Tankel,Alan, AU - Gavaghan,Chris, AU - Holdgate,Anna, AU - Brown,Simon G A, AU - Isbister,Geoffrey K, PY - 2010/06/05/received PY - 2010/10/18/accepted PY - 2010/12/15/entrez PY - 2010/12/15/pubmed PY - 2011/2/11/medline SP - 696 EP - 700 JF - The Medical journal of Australia JO - Med. J. Aust. VL - 193 IS - 11-12 N2 - OBJECTIVE: To describe the clinical features and laboratory findings in patients with definite red-bellied black snake (RBBS; Pseudechis porphyriacus) bites, including correlation with results of venom assays. DESIGN, PATIENTS AND SETTING: Prospective cohort study of patients with definite RBBS bites, recruited to the Australian Snakebite Project from January 2002 to June 2010. MAIN OUTCOME MEASURES: Clinical and laboratory features of envenoming; peak venom concentrations and antivenom treatment. RESULTS: There were 81 definite RBBS bites; systemic envenoming occurred in 57 patients (70%) and local envenoming alone occurred in one patient. Systemic envenoming was characterised by local envenoming in 55 patients (96%), systemic symptoms in 54 patients (95%), anticoagulant coagulopathy with a raised activated partial thromboplastin time (aPTT) in 35 patients (61%) and myotoxicity in seven patients (12%). One patient required non-invasive ventilation for severe myotoxicity that resulted in muscle weakness. Three patients developed local ulceration. There were no deaths. Twenty-two envenomed patients (39%) received tiger snake or black snake antivenom, and administration within 6 hours of the bite was associated with normalisation of the aPTT. Eight patients (36%) had immediate hypersensitivity reactions to antivenom, including one case of anaphylaxis. The median peak venom concentration in 37 systemically envenomed patients with serum available was 19 ng/mL (interquartile range, 12-50 ng/mL; range, 3-360 ng/mL), which did not correlate with clinical severity. In 17 patients who received antivenom and had venom concentration measured, no venom was detected in serum after the first antivenom dose, including nine who were given one vial of tiger snake antivenom. CONCLUSION: RBBS envenoming caused local effects, systemic symptoms, anticoagulant coagulopathy and, uncommonly, myotoxicity. One vial of tiger snake or black snake antivenom appears to be sufficient to remove venom and neutralise reversible effects, but hypersensitivity reactions occurred in over a third of patients. SN - 0025-729X UR - https://www.unboundmedicine.com/medline/citation/21143062/Clinical_effects_of_red_bellied_black_snake__Pseudechis_porphyriacus__envenoming_and_correlation_with_venom_concentrations:_Australian_Snakebite_Project__ASP_11__ L2 - https://www.mja.com.au/public/issues/193_11_061210/chu10605_fm.html DB - PRIME DP - Unbound Medicine ER -