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Clinical effects and antivenom dosing in brown snake (Pseudonaja spp.) envenoming--Australian snakebite project (ASP-14).
PLoS One 2012; 7(12):e53188Plos

Abstract

BACKGROUND

Snakebite is a global health issue and treatment with antivenom continues to be problematic. Brown snakes (genus Pseudonaja) are the most medically important group of Australian snakes and there is controversy over the dose of brown snake antivenom. We aimed to investigate the clinical and laboratory features of definite brown snake (Pseudonaja spp.) envenoming, and determine the dose of antivenom required.

METHODS AND FINDING

This was a prospective observational study of definite brown snake envenoming from the Australian Snakebite Project (ASP) based on snake identification or specific enzyme immunoassay for Pseudonaja venom. From January 2004 to January 2012 there were 149 definite brown snake bites [median age 42 y (2-81 y); 100 males]. Systemic envenoming occurred in 136 (88%) cases. All envenomed patients developed venom induced consumption coagulopathy (VICC), with complete VICC in 109 (80%) and partial VICC in 27 (20%). Systemic symptoms occurred in 61 (45%) and mild neurotoxicity in 2 (1%). Myotoxicity did not occur. Severe envenoming occurred in 51 patients (38%) and was characterised by collapse or hypotension (37), thrombotic microangiopathy (15), major haemorrhage (5), cardiac arrest (7) and death (6). The median peak venom concentration in 118 envenomed patients was 1.6 ng/mL (Range: 0.15-210 ng/mL). The median initial antivenom dose was 2 vials (Range: 1-40) in 128 patients receiving antivenom. There was no difference in INR recovery or clinical outcome between patients receiving one or more than one vial of antivenom. Free venom was not detected in 112/115 patients post-antivenom with only low concentrations (0.4 to 0.9 ng/ml) in three patients.

CONCLUSIONS

Envenoming by brown snakes causes VICC and over a third of patients had serious complications including major haemorrhage, collapse and microangiopathy. The results of this study support accumulating evidence that giving more than one vial of antivenom is unnecessary in brown snake envenoming.

Authors+Show Affiliations

Emergency Department, Queen Elizabeth II Jubilee Hospital, Brisbane, 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
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23300888

Citation

Allen, George E., et al. "Clinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja Spp.) envenoming--Australian Snakebite Project (ASP-14)." PloS One, vol. 7, no. 12, 2012, pp. e53188.
Allen GE, Brown SG, Buckley NA, et al. Clinical effects and antivenom dosing in brown snake (Pseudonaja spp.) envenoming--Australian snakebite project (ASP-14). PLoS ONE. 2012;7(12):e53188.
Allen, G. E., Brown, S. G., Buckley, N. A., O'Leary, M. A., Page, C. B., Currie, B. J., ... Isbister, G. K. (2012). Clinical effects and antivenom dosing in brown snake (Pseudonaja spp.) envenoming--Australian snakebite project (ASP-14). PloS One, 7(12), pp. e53188. doi:10.1371/journal.pone.0053188.
Allen GE, et al. Clinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja Spp.) envenoming--Australian Snakebite Project (ASP-14). PLoS ONE. 2012;7(12):e53188. PubMed PMID: 23300888.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical effects and antivenom dosing in brown snake (Pseudonaja spp.) envenoming--Australian snakebite project (ASP-14). AU - Allen,George E, AU - Brown,Simon G A, AU - Buckley,Nicholas A, AU - O'Leary,Margaret A, AU - Page,Colin B, AU - Currie,Bart J, AU - White,Julian, AU - Isbister,Geoffrey K, AU - ,, Y1 - 2012/12/28/ PY - 2012/08/02/received PY - 2012/11/29/accepted PY - 2013/1/10/entrez PY - 2013/1/10/pubmed PY - 2013/6/26/medline SP - e53188 EP - e53188 JF - PloS one JO - PLoS ONE VL - 7 IS - 12 N2 - BACKGROUND: Snakebite is a global health issue and treatment with antivenom continues to be problematic. Brown snakes (genus Pseudonaja) are the most medically important group of Australian snakes and there is controversy over the dose of brown snake antivenom. We aimed to investigate the clinical and laboratory features of definite brown snake (Pseudonaja spp.) envenoming, and determine the dose of antivenom required. METHODS AND FINDING: This was a prospective observational study of definite brown snake envenoming from the Australian Snakebite Project (ASP) based on snake identification or specific enzyme immunoassay for Pseudonaja venom. From January 2004 to January 2012 there were 149 definite brown snake bites [median age 42 y (2-81 y); 100 males]. Systemic envenoming occurred in 136 (88%) cases. All envenomed patients developed venom induced consumption coagulopathy (VICC), with complete VICC in 109 (80%) and partial VICC in 27 (20%). Systemic symptoms occurred in 61 (45%) and mild neurotoxicity in 2 (1%). Myotoxicity did not occur. Severe envenoming occurred in 51 patients (38%) and was characterised by collapse or hypotension (37), thrombotic microangiopathy (15), major haemorrhage (5), cardiac arrest (7) and death (6). The median peak venom concentration in 118 envenomed patients was 1.6 ng/mL (Range: 0.15-210 ng/mL). The median initial antivenom dose was 2 vials (Range: 1-40) in 128 patients receiving antivenom. There was no difference in INR recovery or clinical outcome between patients receiving one or more than one vial of antivenom. Free venom was not detected in 112/115 patients post-antivenom with only low concentrations (0.4 to 0.9 ng/ml) in three patients. CONCLUSIONS: Envenoming by brown snakes causes VICC and over a third of patients had serious complications including major haemorrhage, collapse and microangiopathy. The results of this study support accumulating evidence that giving more than one vial of antivenom is unnecessary in brown snake envenoming. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/23300888/Clinical_effects_and_antivenom_dosing_in_brown_snake__Pseudonaja_spp___envenoming__Australian_snakebite_project__ASP_14__ L2 - http://dx.plos.org/10.1371/journal.pone.0053188 DB - PRIME DP - Unbound Medicine ER -