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Tiger snake (Notechis spp) envenoming: Australian Snakebite Project (ASP-13).
Med J Aust 2012; 197(3):173-7MJ

Abstract

OBJECTIVES

To describe the clinical syndrome associated with definite tiger snake (Notechis spp) envenoming and to examine the ability of tiger snake antivenom (TSAV) to bind free venom in vivo.

DESIGN, SETTING AND PARTICIPANTS

We conducted a prospective cohort study within the Australian Snakebite Project, reviewing all definite tiger snake envenoming cases between October 2004 and June 2011. Definite cases were identified by venom-specific enzyme immunoassay or expert snake identification.

MAIN OUTCOME MEASURES

Clinical effects of tiger snake envenoming; peak venom concentrations; number of vials of antivenom administered.

RESULTS

Fifty-six definite tiger snake envenomings were identified. Clinical effects included venom-induced consumption coagulopathy (VICC) (n = 53), systemic symptoms (n = 45), myotoxicity (n = 11) and neurotoxicity (n = 17). Thrombotic microangiopathy occurred in three patients, all of whom developed acute renal failure. There were no deaths. A bite-site snake venom detection kit test was done in 44 patients, but was positive for tiger snake in only 33 cases. Fifty-three patients received TSAV and eight of these patients had immediate hypersensitivity reactions, severe enough in one case to satisfy diagnostic criteria for severe anaphylaxis. The median peak venom concentration in 50 patients with pretreatment blood samples available was 3.2 ng/mL (interquartile range [IQR], 1-12 ng/mL; range 0.17-152 ng/mL). In 49 patients with post-treatment blood samples available, no venom was detected in serum after the first antivenom dose. Ten patients were given 1 vial of TSAV; the median dose was 2 vials (range, 1-4 vials). Pretreatment serum venom concentrations did not vary significantly between patients given 1 vial of TSAV and those given 2 or more vials.

CONCLUSION

Tiger snake envenoming causes VICC, systemic symptoms, neurotoxicity and myotoxicity. One vial of TSAV, the dose originally recommended when the antivenom was first made available, appears to be sufficient to bind all circulating venom.

Authors+Show Affiliations

Discipline of Clinical Pharmacology, University of Newcastle, Newcastle, NSW. Geoffrey.isbister@newcastle.edu.auNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

22860796

Citation

Isbister, Geoffrey K., et al. "Tiger Snake (Notechis Spp) Envenoming: Australian Snakebite Project (ASP-13)." The Medical Journal of Australia, vol. 197, no. 3, 2012, pp. 173-7.
Isbister GK, O'Leary MA, Elliott M, et al. Tiger snake (Notechis spp) envenoming: Australian Snakebite Project (ASP-13). Med J Aust. 2012;197(3):173-7.
Isbister, G. K., O'Leary, M. A., Elliott, M., & Brown, S. G. (2012). Tiger snake (Notechis spp) envenoming: Australian Snakebite Project (ASP-13). The Medical Journal of Australia, 197(3), pp. 173-7.
Isbister GK, et al. Tiger Snake (Notechis Spp) Envenoming: Australian Snakebite Project (ASP-13). Med J Aust. 2012 Aug 6;197(3):173-7. PubMed PMID: 22860796.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tiger snake (Notechis spp) envenoming: Australian Snakebite Project (ASP-13). AU - Isbister,Geoffrey K, AU - O'Leary,Margaret A, AU - Elliott,Matthew, AU - Brown,Simon G A, PY - 2012/8/7/entrez PY - 2012/8/7/pubmed PY - 2012/10/16/medline SP - 173 EP - 7 JF - The Medical journal of Australia JO - Med. J. Aust. VL - 197 IS - 3 N2 - OBJECTIVES: To describe the clinical syndrome associated with definite tiger snake (Notechis spp) envenoming and to examine the ability of tiger snake antivenom (TSAV) to bind free venom in vivo. DESIGN, SETTING AND PARTICIPANTS: We conducted a prospective cohort study within the Australian Snakebite Project, reviewing all definite tiger snake envenoming cases between October 2004 and June 2011. Definite cases were identified by venom-specific enzyme immunoassay or expert snake identification. MAIN OUTCOME MEASURES: Clinical effects of tiger snake envenoming; peak venom concentrations; number of vials of antivenom administered. RESULTS: Fifty-six definite tiger snake envenomings were identified. Clinical effects included venom-induced consumption coagulopathy (VICC) (n = 53), systemic symptoms (n = 45), myotoxicity (n = 11) and neurotoxicity (n = 17). Thrombotic microangiopathy occurred in three patients, all of whom developed acute renal failure. There were no deaths. A bite-site snake venom detection kit test was done in 44 patients, but was positive for tiger snake in only 33 cases. Fifty-three patients received TSAV and eight of these patients had immediate hypersensitivity reactions, severe enough in one case to satisfy diagnostic criteria for severe anaphylaxis. The median peak venom concentration in 50 patients with pretreatment blood samples available was 3.2 ng/mL (interquartile range [IQR], 1-12 ng/mL; range 0.17-152 ng/mL). In 49 patients with post-treatment blood samples available, no venom was detected in serum after the first antivenom dose. Ten patients were given 1 vial of TSAV; the median dose was 2 vials (range, 1-4 vials). Pretreatment serum venom concentrations did not vary significantly between patients given 1 vial of TSAV and those given 2 or more vials. CONCLUSION: Tiger snake envenoming causes VICC, systemic symptoms, neurotoxicity and myotoxicity. One vial of TSAV, the dose originally recommended when the antivenom was first made available, appears to be sufficient to bind all circulating venom. SN - 1326-5377 UR - https://www.unboundmedicine.com/medline/citation/22860796/Tiger_snake__Notechis_spp__envenoming:_Australian_Snakebite_Project__ASP_13__ L2 - https://www.mja.com.au/doi/10.5694/mja11.11300 DB - PRIME DP - Unbound Medicine ER -