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Australian taipan (Oxyuranus spp.) envenoming: clinical effects and potential benefits of early antivenom therapy - Australian Snakebite Project (ASP-25).
Clin Toxicol (Phila) 2017; 55(2):115-122CT

Abstract

CONTEXT

Taipans (Oxyuranus spp.) are medically important venomous snakes from Australia and Papua New Guinea. The objective of this study was to describe taipan envenoming in Australian and its response to antivenom.

METHODS

Confirmed taipan bites were recruited from the Australian Snakebite Project. Data were collected prospectively on all snakebites, including patient demographics, bite circumstances, clinical effects, laboratory results, complications and treatment. Blood samples were taken and analysed by venom specific immunoassay to confirm snake species and measure venom concentration pre- and post-antivenom.

RESULTS

There were 40 confirmed taipan bites: median age 41 years (2-85 years), 34 were males and 21 were snake handlers. Systemic envenoming occurred in 33 patients with neurotoxicity (26), complete venom induced consumption coagulopathy (VICC) (16), partial VICC (15), acute kidney injury (13), myotoxicity (11) and thrombocytopenia (7). Venom allergy occurred in seven patients, three of which had no evidence of envenoming and one died. Antivenom was given to 34 patients with a median initial dose of one vial (range 1-4), and a median total dose of two vials (range 1-9). A greater total antivenom dose was associated with VICC, neurotoxicity and acute kidney injury. Early antivenom administration was associated with a decreased frequency of neurotoxicity, acute kidney injury, myotoxicity and intubation. There was a shorter median time to discharge of 51 h (19-432 h) in patients given antivenom <4 h post-bite, compared to 175 h (27-1104 h) in those given antivenom >4 h. Median peak venom concentration in 25 patients with systemic envenoming and a sample available was 8.4 ng/L (1-3212 ng/L). No venom was detected in post-antivenom samples, including 20 patients given one vial initially and five patients bitten by inland taipans.

DISCUSSION

Australian taipan envenoming is characterised by neurotoxicity, myotoxicity, coagulopathy, acute kidney injury and thrombocytopenia. One vial of antivenom binds all measurable venom and early antivenom was associated with a favourable outcome.

Authors+Show Affiliations

a Clinical Toxicology Research Group, University of Newcastle , Newcastle , Australia.a Clinical Toxicology Research Group, University of Newcastle , Newcastle , Australia.a Clinical Toxicology Research Group, University of Newcastle , Newcastle , Australia.b Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital and the University of Western Australia , Perth , Australia.a Clinical Toxicology Research Group, University of Newcastle , Newcastle , Australia. c Department of Clinical Toxicology and Pharmacology , Calvary Mater Newcastle , Newcastle , Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27903075

Citation

Johnston, Christopher I., et al. "Australian Taipan (Oxyuranus Spp.) Envenoming: Clinical Effects and Potential Benefits of Early Antivenom Therapy - Australian Snakebite Project (ASP-25)." Clinical Toxicology (Philadelphia, Pa.), vol. 55, no. 2, 2017, pp. 115-122.
Johnston CI, Ryan NM, O'Leary MA, et al. Australian taipan (Oxyuranus spp.) envenoming: clinical effects and potential benefits of early antivenom therapy - Australian Snakebite Project (ASP-25). Clin Toxicol (Phila). 2017;55(2):115-122.
Johnston, C. I., Ryan, N. M., O'Leary, M. A., Brown, S. G., & Isbister, G. K. (2017). Australian taipan (Oxyuranus spp.) envenoming: clinical effects and potential benefits of early antivenom therapy - Australian Snakebite Project (ASP-25). Clinical Toxicology (Philadelphia, Pa.), 55(2), pp. 115-122. doi:10.1080/15563650.2016.1250903.
Johnston CI, et al. Australian Taipan (Oxyuranus Spp.) Envenoming: Clinical Effects and Potential Benefits of Early Antivenom Therapy - Australian Snakebite Project (ASP-25). Clin Toxicol (Phila). 2017;55(2):115-122. PubMed PMID: 27903075.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Australian taipan (Oxyuranus spp.) envenoming: clinical effects and potential benefits of early antivenom therapy - Australian Snakebite Project (ASP-25). AU - Johnston,Christopher I, AU - Ryan,Nicole M, AU - O'Leary,Margaret A, AU - Brown,Simon G A, AU - Isbister,Geoffrey K, Y1 - 2016/11/30/ PY - 2016/12/3/pubmed PY - 2017/2/28/medline PY - 2016/12/2/entrez KW - Australia KW - antivenom KW - envenoming KW - snakebite KW - taipan SP - 115 EP - 122 JF - Clinical toxicology (Philadelphia, Pa.) JO - Clin Toxicol (Phila) VL - 55 IS - 2 N2 - CONTEXT: Taipans (Oxyuranus spp.) are medically important venomous snakes from Australia and Papua New Guinea. The objective of this study was to describe taipan envenoming in Australian and its response to antivenom. METHODS: Confirmed taipan bites were recruited from the Australian Snakebite Project. Data were collected prospectively on all snakebites, including patient demographics, bite circumstances, clinical effects, laboratory results, complications and treatment. Blood samples were taken and analysed by venom specific immunoassay to confirm snake species and measure venom concentration pre- and post-antivenom. RESULTS: There were 40 confirmed taipan bites: median age 41 years (2-85 years), 34 were males and 21 were snake handlers. Systemic envenoming occurred in 33 patients with neurotoxicity (26), complete venom induced consumption coagulopathy (VICC) (16), partial VICC (15), acute kidney injury (13), myotoxicity (11) and thrombocytopenia (7). Venom allergy occurred in seven patients, three of which had no evidence of envenoming and one died. Antivenom was given to 34 patients with a median initial dose of one vial (range 1-4), and a median total dose of two vials (range 1-9). A greater total antivenom dose was associated with VICC, neurotoxicity and acute kidney injury. Early antivenom administration was associated with a decreased frequency of neurotoxicity, acute kidney injury, myotoxicity and intubation. There was a shorter median time to discharge of 51 h (19-432 h) in patients given antivenom <4 h post-bite, compared to 175 h (27-1104 h) in those given antivenom >4 h. Median peak venom concentration in 25 patients with systemic envenoming and a sample available was 8.4 ng/L (1-3212 ng/L). No venom was detected in post-antivenom samples, including 20 patients given one vial initially and five patients bitten by inland taipans. DISCUSSION: Australian taipan envenoming is characterised by neurotoxicity, myotoxicity, coagulopathy, acute kidney injury and thrombocytopenia. One vial of antivenom binds all measurable venom and early antivenom was associated with a favourable outcome. SN - 1556-9519 UR - https://www.unboundmedicine.com/medline/citation/27903075/Australian_taipan__Oxyuranus_spp___envenoming:_clinical_effects_and_potential_benefits_of_early_antivenom_therapy___Australian_Snakebite_Project__ASP_25__ L2 - http://www.tandfonline.com/doi/full/10.1080/15563650.2016.1250903 DB - PRIME DP - Unbound Medicine ER -