VENOMOUS SNAKE

BITES &
OTHER BITES AND
STINGS
DR. HYDER ALI OMER, MBBS-ABIM
CONST. NEPHROLOGIST-ACH
LECTURER IN MEDICINE
COLLEGE OF MEDICINE
KING KHALID UNIVERSITY

VENOMOUS SNAKE BITES

EPIDEMIOLOGY
1. The venomous snakes are grouped in to the
families:(A) Viperidae e.g. Asian pit vipers
(B) Elapidae
e. g. Cobras and coral snakes
(C) Hydrophiidae e.g. Sea snakes
(D) Atracta Spididae e.g. The burrowing asps
(E) Colubridae

2. Bites rates are highest in temperate and

tropical regions where people subset by
manual agriculture.
3. Global Estimates: Suggest that around 30,000
to 40,000 persons die each year from
venomous snake bites.

SNAKE ANATOMY &

IDENTIFICATION

1. The typical snake venom apparatus consists of

B/L venom glands, connected by ducts to
hollow, anterior maxillary teeth.
2. Venomous snakes can bite without injecting
venom.
3. Differentiation of venomous from non-venomous
snake species can be difficult.

4. In many areas of the world such

as Australia ELISA, KITS are available
to help in determining the specific
snake species involved in a bite.
These KITS identify venom in the
victims blood, urine or wound
aspirate.

Venoms &Clinical manifestations

1. Snake venoms are complex mixtures of :-Enzyms
-Low molecular w+ polypeptides
-Glycoproteins &
- Metal ions
2. Among the the deleterious components are
hemorrhagins which can lead to local and
systemic bleeding.

3. Various proteolytic enzymes cause

1. Local tissue necrosis
2. Affect the coagulation pathway
3. and impair organ function.

4. Myocardial depressant factors reduce

cardiac output.

5- Neurotoxins

act either pre or

post-synoptically to inhibit
peripheral nerve
impulses.
6. Most snake venoms have multisystem effects in their victims

TREATMENT
Field Management
1. Initial measures should

focus on rapidly delivering

the victim to definitive medical

care while keeping the patient as inactive as possible to limit systemic spread of venom.

2.

Mechanical Suction.
-Was practiced for many years.

- Proved to be of little benefit.

3. Lymph Occlusive Constriction
Bands. (L.O.B)
Despite some evidence that venom can
be localized to the bite site by L-O-Bands
combined with splinting, the clinical
benefit of these techniques has never
been demonstrated.

Restricting venom to the bite site may

worsen local tissue necrosis
If the victim is > 1 hour from medical care
a constriction band may be considered.
Total occlusive arterial tourniquet should
NEVER be employed.

Avoid the following

- Incising the bite site.

- Cooling the bite site.
-Alcoholic beverages. Or
- Applying electric shocks.
The bitten extremity should be
splinted and kept at heart level.

HOSPITAL MANAGEMENT

Admit to an intensive care setting.

2. Monitor vital signs , cardiac
rhythm and O2- SAT
1.

3. Obtain a quick history and perform a

rapid but thorough physical
examination.
4. Establish an I.V access

Treat Hypotension with: (i) I.V. FLUIDS (N/SOrR/L)20-40 ml /Kg

of Body wt.
(ii) If no response to iv fluids add 5%
Albumin 10-20ml/Kg body weight.
(iii) if no response to the above measures
and antivenom infusion then use
vasopressors.

6.

Send blood samples for CBC

coagulation profile, RFT, LFT,
grouping & X matching.
7. Urine for myoglobin and
blood.
8. ECG, C Xray & ABG
9.

Antivenom should be given

early.

10.

The package insert

accompanying a particular
antivenom should be consulted for
information regarding the
spectrum of coverage.

11.

Progressive or severe local

findings or manifestation of
systemic toxicity (Signs&
Symptoms OR LAB
abnormalities are indication for
administration of antivenom.

Sample Grading Scale for Use in

Viperid Poisoning.
Severity

Local findings

Systemic
findings

Lab
Abnormalities

Dry Bite
(no venom)

Non or
puncture
wounds only

none

Normal

Mild

Puncture
none
wound pain,
swelling to the
bite site

Normal

Moderate

Severe

Swelling
extending
beyond the
local bite site

Mild e.g.
Nausea,
vomiting
muscle
fasiculations

Severe pain & Severe Resp.

swelling
Distress,BP
and bleeding

Abnormal PLT
count Or
Fibrinogen
(Mildly
abnormal)
Very abnormal

Comparison of Antivenoms for treatment of Pit

viper bites.

Antivenin
(Polyvalent)

CROFAB

Available since

1954 - Equine

2000 - Ovine

Snakes covered

All north, south &Central

American and some Asian
pit vipers

All north
American pit
vipers

Contains

IgG, Equine Albumin

Fab fragments

Skin test

Yes

No

Dosing
Dry Bite
Mild
Moderate
Severe
Repeat Dosing

None
0-5 vials
10 vials
15-20 vials
As needed

None
4-6 vials
4-6 vials
6 vials

Volume of diluents

1000 ml ( for children 250 ml

and CHF)

Administer over

2 hours

1 hour

Incidence of
anaphylaxis

23-56%

14%

WIDO SPIDER BITES

1. The

Black widow
spider is
(LATRODECTUS
MACTANS)
Found in tropics,
North America &
Mediterranean
countries.

2.SYMPTOMS AND SIGNS.

pain at bite site

- Generalized muscle pain
- Sweating & salivation
- Headache
- Hypertension may occur
- Extreme Rigidity of abdominal
muscles and severe pain.
- Abdomen is not tender on palpation.
- R. Failure may occur secondary to
Rhabdomyolysis

- Severe

Treatment
3. Consists of :
(i)
Local cleansing
(ii) Application of ice packs
(iii) Tetanus proplylaxis
(iv) Treat BP
(v) Antivenom specific for
spider bite rapidly relieves
pain and can be life saving.

Scorpion stings

1. Scorpion stings are a serious problem in middle

east, North Africa& America
2. Scorpion venoms stimulate the release of
Ac-choline and Catecholamines causing
both cholinergic and adrenergic symptoms.
3. Severe pain occurs immediately at the site of
puncture followed by swelling.

4. : Signs of systemic involvement

includes :vomiting,sweating, piloerection, abd. Pain,

and Diarrhea.
In some cases depending on the species
shock , respiratory depression and
pulmonary oedema
may occur.

Treatment
1.

Local infiltration with anesthetic will alleviate

local pain

2. Specific Antivenom should given as soon as

possible