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Clinic

 

Tropidechis carinatus

Studies

Trinca et al. 1971: 12 T. carinatus bites; identification: morphological; retrospective case collection.

Case reports

Patten et al. 1985:T. carinatus bite; identification: ELISA (cross-reaction:  T. carinatus/Notechis scutatus); distribution ( T. carinatus is common in the region in which the accident occurred, Notechis scutatus rare); clinical picture (rhabdomyolysis and electrophysiological investigations in experimental envenoming are consistent with the clinical observations in this case).

Pearn 1987: 3 T. carinatus bites (1 case identical to the case of Patten et al. 1985); identification: see above for reasoning.

Sutherland 1983: 5 T. carinatus bites; identification: morphological.

Signs & symptoms

Autopharmacological effects

Nausea 5/12, vomiting 6/12, abdominal pain 5/12, sweating 4/12, headache 5/12, loss of consciousness 2/12 (Trinca et al. 1971); vomiting, loss of consciousness (Patten et al. 1985) (these symptoms appeared very rapidly, sometimes within minutes).

Local effects

Minimal local effects (pain, swelling) (White 1987b).

Haemostatic effects

Blood in the urine 1/12, vomiting blood 1/12 (Trinca et al. 1971). Seeping bleeding from previous venipunctures (Patten et al. 1985).

Neurological effects

Diplopia 1/12, blurred vision 3/12, dysarthria 3/12, paralysis of the extremities 3/12, impairment of the respiratory musculature (dyspnoea) 4/12 (Trinca et al. 1971).

Flaccid paralysis (Patten et al. 1985).

Muscular effects

Muscle stiffness (neck) 1/12 (Trinca et al. 1971). Pain in the thorax, abdomen and extremities; progressive muscle weakness. Dark urine (myoglobin) from 24 hours after the bite (Patten et al. 1985).

Renal effects

Acute renal failure developed within 48 hours after the bite (status after resuscitation due to cardiopulmonary failure, rhabdomyolysis) (secondary renal failure) (Patten et al. 1985).

Morbidity

Regeneration of the musculature over a period of weeks (Patten et al. 1985).

Renal failure (Patten et al. 1985).

Dysphagia (Trinca et al. 1971, Patten et al. 1985).

Case fatality rate

1/12; death occurred within minutes (autopharmacological effect of the venom?) (Trinca et al. 1971).

Laboratory and physical investigations

1. Haemostasis
Type of haemostatic defect
Prothrombin activation (Rosing et al. 1988).

Haemostatic parameters

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

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

No clinical investigations of the course of haemostasis are available. The initial haemostatic profile of a child who was bitten showed a mild coagulation defect, TT 15 s (normal 9–11 s), FSPs 20 mg/l (normal <20 mg/l) (Patten et al. 1985). A further case with a haemostatic defect: PT 53 s (control 12 s), aPTT >8 min (Sutherland 1983).

 

2. Serum creatinine phosphokinase (CPK)

380,000 U/l (normal 0.35–2.10 U/l) (Patten et al. 1985).

 

3. Urine myoglobin

Marked increase. From the 35th day after the bite myoglobinuria no longer present (Patten et al. 1985).

 

4. Hypocalcaemia

Hypocalcaemia due to the release of phosphate from the rhabdomyolysis and the deposition of calcium in areas with muscular necrosis (Patten et al. 1985).

 

5. ELISA

Cross-reaction: Tropidechis carinatus/Notechis scutatus (Patten et al. 1985).

 

6. EMG

Loss of numerous motor units. The remaining units showed myopathic potentials (small-amplitude, polyphasic potentials) (Patten et al. 1985).

Treatment (symptomatic)

  1. Resuscitation after cardiopulmonary failure (Patten et al. 1985).
  2. Endotracheal intubation and artificial respiration: implemented successfully over a period of 11 weeks with complete recovery as a result (Patten et al. 1985).
  3. Dialysis.
  4. Treatment of hyperkalaemia (Patten et al. 1985).

Treatment (specific)

Studies
No controlled clinical studies available. Information on the efficacy of antivenom in Trinca et al. 1971 and Patten et al. 1985.


Antivenoms (Sutherland 1983)
Tiger snake antivenom, CSL, Parkville, Australia.
Polyvalent (Australia, New Guinea), CSL, Parkville, Australia.
 
Efficacy

5/12 patients received antivenom, which appeared to be effective in 4/5 (Trinca et al. 1971). Antivenom was effective up to 90 h after the bite with regard to the neurotoxic effects of the venom. The neurotoxic effects were reversed, at least temporarily. This was not the case for the myotoxic effects, i.e. the rhabdomyolysis (Patten et al. 1985).