Document Detail

Tiger snake (Notechis spp) envenoming: Australian Snakebite Project (ASP-13).
MedLine Citation:
PMID:  22860796     Owner:  NLM     Status:  MEDLINE    
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.
Geoffrey K Isbister; Margaret A O'Leary; Matthew Elliott; Simon G A Brown
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  The Medical journal of Australia     Volume:  197     ISSN:  1326-5377     ISO Abbreviation:  Med. J. Aust.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-06     Completed Date:  2012-10-15     Revised Date:  2013-04-10    
Medline Journal Info:
Nlm Unique ID:  0400714     Medline TA:  Med J Aust     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  173-7     Citation Subset:  IM    
Discipline of Clinical Pharmacology, University of Newcastle, Newcastle, NSW.
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MeSH Terms
Aged, 80 and over
Antivenins / administration & dosage,  therapeutic use*
Child, Preschool
Immunoenzyme Techniques
Middle Aged
Prospective Studies
Snake Bites / therapy*
Snake Venoms / antagonists & inhibitors,  blood
Young Adult
Reg. No./Substance:
0/Antivenins; 0/Snake Venoms
Comment In:
Med J Aust. 2013 Mar 4;198(4):194   [PMID:  23451957 ]
Med J Aust. 2013 Mar 4;198(4):194-5   [PMID:  23451958 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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