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Local morbidity from red-bellied black snake (Pseudechis porphyriacus, Elapidae) envenoming: Two cases and a brief review of management.
Toxicon 2018; 142:34-41T

Abstract

The red-bellied black snake (Pseudechis porphyriacus, Elapidae) is one of several species of venomous snakes most commonly implicated in human and domestic animal envenoming in Australia. Human systemic envenoming can present with myotoxicity that may include myoglobinuria; hemoglobinuria and intravascular hemolysis; thrombocytopenia, anticoagulant coagulopathy, and, rarely, mild cranial nerve palsies. Pseudechis porphyriacus envenoming can also feature significant local morbidity such as ecchymoses, bleeding, pain and necrosis. Some envenomed patients may develop progressive thickness necrosis independent of secondary infection, and occasionally require surgical debridement. Uncommonly, some digital envenoming may cause more severe deeper tissue pathology that justifies dermotomy and/or distal phalangeal amputation. Presented are two patients with significant local morbidity from P. porphyriacus envenoming. An 18-month old girl received a protracted envenoming on her right foot, while a 38-year old male professional zoologist was envenomed on the third digit of his right hand. Each patient experienced myotoxicity, one had anticoagulant coagulopathy, and both developed clinically significant local morbidity including persistent bleeding, ecchymoses, local necrosis and pain; each required extensive treatment and variably prolonged admission. Noted also were transiently elevated D-dimer with low-normal or normal fibrinogen levels. The progressive necrosis and subsequent chronic pathologic changes with ischemia of the latter patient's digit eventually required a dermotomy and amputation of the distal phalanx. The pediatric patient did not require extensive wound debridement, but experienced prolonged difficulty in ambulation because of slowly resolving wound discomfort. Factors that may contribute to the severity of local morbidity of P. porphyriacus envenoming are considered, and management of envenoming by this taxon is briefly reviewed.

Authors+Show Affiliations

Toxinology Department, Women's and Children's Hospital, 72 King William St, North Adelaide, South Australia 5006, Australia; Department of Paediatrics and Reproductive Medicine, University of Adelaide School of Medicine, 30 Frome Street, Adelaide, South Australia 5005, Australia. Electronic address: herptoxmed@msn.com.44 Ibis Road, Clayton Bay, South Australia 5256, Australia.Reef HQ Aquarium, Great Barrier Reef Marine Park Authority, 2-68 Flinders St, PO Box 1379, Townsville, Queensland 4810, Australia.Department of Emergency Medicine, The Townsville Hospital, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia; College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia.Toxinology Department, Women's and Children's Hospital, 72 King William St, North Adelaide, South Australia 5006, Australia; Department of Paediatrics and Reproductive Medicine, University of Adelaide School of Medicine, 30 Frome Street, Adelaide, South Australia 5005, Australia.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29269114

Citation

Weinstein, Scott A., et al. "Local Morbidity From Red-bellied Black Snake (Pseudechis Porphyriacus, Elapidae) Envenoming: Two Cases and a Brief Review of Management." Toxicon : Official Journal of the International Society On Toxinology, vol. 142, 2018, pp. 34-41.
Weinstein SA, Mirtschin PJ, Tristram H, et al. Local morbidity from red-bellied black snake (Pseudechis porphyriacus, Elapidae) envenoming: Two cases and a brief review of management. Toxicon. 2018;142:34-41.
Weinstein, S. A., Mirtschin, P. J., Tristram, H., Lawton, L., & White, J. (2018). Local morbidity from red-bellied black snake (Pseudechis porphyriacus, Elapidae) envenoming: Two cases and a brief review of management. Toxicon : Official Journal of the International Society On Toxinology, 142, pp. 34-41. doi:10.1016/j.toxicon.2017.12.047.
Weinstein SA, et al. Local Morbidity From Red-bellied Black Snake (Pseudechis Porphyriacus, Elapidae) Envenoming: Two Cases and a Brief Review of Management. Toxicon. 2018;142:34-41. PubMed PMID: 29269114.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Local morbidity from red-bellied black snake (Pseudechis porphyriacus, Elapidae) envenoming: Two cases and a brief review of management. AU - Weinstein,Scott A, AU - Mirtschin,Peter J, AU - Tristram,Hamish, AU - Lawton,Luke, AU - White,Julian, Y1 - 2017/12/19/ PY - 2017/10/19/received PY - 2017/12/14/revised PY - 2017/12/17/accepted PY - 2017/12/23/pubmed PY - 2018/11/15/medline PY - 2017/12/23/entrez KW - Envenoming KW - Local morbidity KW - Management KW - Pseudechis porphyriacus KW - Red-bellied black snake KW - Wound necrosis SP - 34 EP - 41 JF - Toxicon : official journal of the International Society on Toxinology JO - Toxicon VL - 142 N2 - The red-bellied black snake (Pseudechis porphyriacus, Elapidae) is one of several species of venomous snakes most commonly implicated in human and domestic animal envenoming in Australia. Human systemic envenoming can present with myotoxicity that may include myoglobinuria; hemoglobinuria and intravascular hemolysis; thrombocytopenia, anticoagulant coagulopathy, and, rarely, mild cranial nerve palsies. Pseudechis porphyriacus envenoming can also feature significant local morbidity such as ecchymoses, bleeding, pain and necrosis. Some envenomed patients may develop progressive thickness necrosis independent of secondary infection, and occasionally require surgical debridement. Uncommonly, some digital envenoming may cause more severe deeper tissue pathology that justifies dermotomy and/or distal phalangeal amputation. Presented are two patients with significant local morbidity from P. porphyriacus envenoming. An 18-month old girl received a protracted envenoming on her right foot, while a 38-year old male professional zoologist was envenomed on the third digit of his right hand. Each patient experienced myotoxicity, one had anticoagulant coagulopathy, and both developed clinically significant local morbidity including persistent bleeding, ecchymoses, local necrosis and pain; each required extensive treatment and variably prolonged admission. Noted also were transiently elevated D-dimer with low-normal or normal fibrinogen levels. The progressive necrosis and subsequent chronic pathologic changes with ischemia of the latter patient's digit eventually required a dermotomy and amputation of the distal phalanx. The pediatric patient did not require extensive wound debridement, but experienced prolonged difficulty in ambulation because of slowly resolving wound discomfort. Factors that may contribute to the severity of local morbidity of P. porphyriacus envenoming are considered, and management of envenoming by this taxon is briefly reviewed. SN - 1879-3150 UR - https://www.unboundmedicine.com/medline/citation/29269114/Local_morbidity_from_red_bellied_black_snake__Pseudechis_porphyriacus_Elapidae__envenoming:_Two_cases_and_a_brief_review_of_management_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-0101(17)30407-5 DB - PRIME DP - Unbound Medicine ER -