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Poisonous animals
 
Cnidarians (Jellyfish, Corals and Anemones)
 
Venomous fish
 
Scorpions
 
Spiders
 
Hymenopterans (Bees, Wasps and Ants)
 
Sea snakes
 
Terrestrial snakes
 
Miscellaneous animals
 
North America
 
Mexico and Central America
 
South America and the West Indies
 
Europe
 
North Africa, Near and Middle East
 
Central and Southern Africa
 
The Far East
 
Indian Subcontinent and Southeast Asia
 
Australia and the Pacific Islands
 
 
 
 
 
 
 
 

Clinic

 

Dispholidus typus

Case reports

Pope 1958, Spies et al. 1962, Lakier and Fritz 1969, Mackay et al. 1969, Matell et al. 1973, Nicolson et al. 1974, Visser and Chapman 1978, Gerber and Adendorf 1980, Geddes and Thomas 1985, Broadley 1960

Signs & symptoms

(Minton 1990b and case reports)

Autopharmacological effects

Nausea, vomiting, diarrhoea.

Local effects

Limited local effect.

Haemostatic effects

Gingival bleeding, epistaxis, haemoptysis, haematuria, bleeding per rectum, melaena, extensive subcutaneous and intracranial bleeding (within hours).

Renal effects

Acute kidney failure (secondary to DIC).

Other symptoms & findings

Headache.

Morbidity

Acute kidney failure (Lakier and Fritz 1969).

Case fatality rate

1/1 Intracranial bleeding (Pope 1958).

Laboratory and physical investigations

1. Haemostasis

Type of haemostatic defect
DIC due to activation of factor X and direct conversion of prothrombin to thrombin (Mackay et al. 1969). Thrombopaenia in the context of DIC. Haemorrhagic effect (Christensen, pers. commun. cited in Nicolson et al. 1974).

 

Overview haemostasis
   
A
 
   
B
 
B
 
D
 
 
E
 
                     
 
H CT (FSP) Tc PT aPTT TT I FSP D II V VIII X XIII PC ATIII PI tPA α2AP
       
 
F
     
 
C
                       
 

Essential

bed-side

tests

Tests for full clinical assessment Tests for research purposes
H haemorhagic effects
+ definite evidence in
human envenoming
CT full blood clotting test
(FSP)  FSP rapid test
Tc platlets
PT prothrombin time
aPTT partial thromboplastin time
TT thrombin time
I fibrinogen
FSP  fibrinogen split products
D D-dimer
II, V, VII, X, XIII
  clotting factors
PC protein C
ATIII antithrombin III
PI plasminogen
tPA tissue plasmin activator
α2AP α2-antiplasmin
 
In this overview, the deviations from normal
are recorded for those haemostasis para-
meters only, for which good evidence is
documented in the literature.

 

A CT: increased.
B PT, aPTT: increased.
C Fibrinogen: 0.35 g/l (Geddes and Thomas 1985); 0.1 g/l (Lakier and Fritz 1969).
D TT: increased.
E FSP: ≥1,280 g/ml ≤2,660 g/l (Geddes and Thomas 1985).
F Platelets: minimum 8,000/mm3 (Nicolson et al. 1974); minimum 10,000/mm3 (Lakier and Fritz 1969).

 

2. Signs of haemolysis in the context of DIC

(Lakier and Fritz 1969, Nicolson et al. 1974).

 

3. Haemoglobin

Minimum 7.4 g/100 ml (initial value 18.1 g/100 ml) (Lakier and Fritz 1969).
Minimum 10.8 g/ml (initial value 13 g/ml) (Nicolson et al. 1974).

Treatment (symptomatic)

  1. Blood transfusion
  2. Dialysis.

Treatment (specific)

Antivenoms

Boomslang antivenom (SAIMR).

 

Indications for administration of antivenom

Systemic bleeding.
Confirmation of haemostatic defect with the relevant haemostatic tests (see above).

 

Dose

20 ml (i.v.) (Geddes and Thomas 1985).
40 ml (i.v.) (Nicolson et al. 1974).
40 ml (i.v.) (Lakier and Fritz 1969).

 

Efficacy with regard to haemostatic effects

  • Clinical:
    Systemic bleeding ceased immediately after administration of antivenom (Geddes and Thomas 1985). Systemic bleeding ceased within hours (Nicolson et al. 1974).
  • Coagulation defect (laboratory investigations):
    Normalization of aPTT within 8 h (Geddes and Thomas 1985). Normalization of clotting time, TT and fibrinogen within hours (Nicolson et al. 1974). Normalization of coagulation tests within 72 h (Lakier and Fritz 1969).
  • Thrombopaenia (laboratory investigations):
    Increase in platelets within hours, normalization within 5 days (Nicolson et al. 1974). Increase in platelets within 24 h, normalization within 7 days (Lakier and Fritz 1969).

 

Adverse reactions

Immediate hypersensitivity (Nicolson et al. 1974, Lakier and Fritz 1969).
Pyrogenic reaction (Geddes and Thomas 1985).
Serum sickness (Nicolson et al. 1974).

 

Evaluation and recommendations

According to these few case reports, the specific antivenom appears to be effective with regard to the haemostatic defect (in particular the coagulation defect).