Clinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja spp.) Envenoming - Australian Snakebite Project (ASP-14)

G Allen, Simon Brown, Nicholas Buckley, Margaret O'Leary, Colin B Page, Bart Currie, Julian White, Geof Isbister

    Research output: Contribution to journalArticleResearchpeer-review

    1 Downloads (Pure)

    Abstract

    Background: Snakebite is a global health issue and treatment with antivenom continues to be problematic. Brown snakes (genus Pseudonaja) are the most medically important group of Australian snakes and there is controversy over the dose of brown snake antivenom. We aimed to investigate the clinical and laboratory features of definite brown snake (Pseudonaja spp.) envenoming, and determine the dose of antivenom required.

    Methods and Finding: This was a prospective observational study of definite brown snake envenoming from the Australian Snakebite Project (ASP) based on snake identification or specific enzyme immunoassay for Pseudonaja venom. From January 2004 to January 2012 there were 149 definite brown snake bites [median age 42y (2–81y); 100 males]. Systemic envenoming occurred in 136 (88%) cases. All envenomed patients developed venom induced consumption coagulopathy (VICC), with complete VICC in 109 (80%) and partial VICC in 27 (20%). Systemic symptoms occurred in 61 (45%) and mild neurotoxicity in 2 (1%). Myotoxicity did not occur. Severe envenoming occurred in 51 patients (38%) and was characterised by collapse or hypotension (37), thrombotic microangiopathy (15), major haemorrhage (5), cardiac arrest (7) and death (6). The median peak venom concentration in 118 envenomed patients was 1.6 ng/mL (Range: 0.15–210 ng/mL). The median initial antivenom dose was 2 vials (Range: 1–40) in 128 patients receiving antivenom. There was no difference in INR recovery or clinical outcome between patients receiving one or more than one vial of antivenom. Free venom was not detected in 112/115 patients post-antivenom with only low concentrations (0.4 to 0.9 ng/ml) in three patients.

    Conclusions: Envenoming by brown snakes causes VICC and over a third of patients had serious complications including major haemorrhage, collapse and microangiopathy. The results of this study support accumulating evidence that giving more than one vial of antivenom is unnecessary in brown snake envenoming.
    Original languageEnglish
    Article numbere53188
    Pages (from-to)1-9
    Number of pages9
    JournalPLoS One
    Volume7
    Issue number12
    DOIs
    Publication statusPublished - 2012

    Fingerprint

    antivenoms
    snake bites
    Antivenins
    Snake Bites
    Snakes
    venoms
    snakes
    Venoms
    Disseminated Intravascular Coagulation
    microangiopathy
    hemorrhage
    Hemorrhage
    Thrombotic Microangiopathies
    cardiac arrest
    overdose
    Snake Venoms
    neurotoxicity
    International Normalized Ratio
    hypotension
    enzyme immunoassays

    Cite this

    Allen, G ; Brown, Simon ; Buckley, Nicholas ; O'Leary, Margaret ; Page, Colin B ; Currie, Bart ; White, Julian ; Isbister, Geof. / Clinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja spp.) Envenoming - Australian Snakebite Project (ASP-14). In: PLoS One. 2012 ; Vol. 7, No. 12. pp. 1-9.
    @article{b3875fe4870f4eb88f5288803938cfc2,
    title = "Clinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja spp.) Envenoming - Australian Snakebite Project (ASP-14)",
    abstract = "Background: Snakebite is a global health issue and treatment with antivenom continues to be problematic. Brown snakes (genus Pseudonaja) are the most medically important group of Australian snakes and there is controversy over the dose of brown snake antivenom. We aimed to investigate the clinical and laboratory features of definite brown snake (Pseudonaja spp.) envenoming, and determine the dose of antivenom required.Methods and Finding: This was a prospective observational study of definite brown snake envenoming from the Australian Snakebite Project (ASP) based on snake identification or specific enzyme immunoassay for Pseudonaja venom. From January 2004 to January 2012 there were 149 definite brown snake bites [median age 42y (2–81y); 100 males]. Systemic envenoming occurred in 136 (88{\%}) cases. All envenomed patients developed venom induced consumption coagulopathy (VICC), with complete VICC in 109 (80{\%}) and partial VICC in 27 (20{\%}). Systemic symptoms occurred in 61 (45{\%}) and mild neurotoxicity in 2 (1{\%}). Myotoxicity did not occur. Severe envenoming occurred in 51 patients (38{\%}) and was characterised by collapse or hypotension (37), thrombotic microangiopathy (15), major haemorrhage (5), cardiac arrest (7) and death (6). The median peak venom concentration in 118 envenomed patients was 1.6 ng/mL (Range: 0.15–210 ng/mL). The median initial antivenom dose was 2 vials (Range: 1–40) in 128 patients receiving antivenom. There was no difference in INR recovery or clinical outcome between patients receiving one or more than one vial of antivenom. Free venom was not detected in 112/115 patients post-antivenom with only low concentrations (0.4 to 0.9 ng/ml) in three patients.Conclusions: Envenoming by brown snakes causes VICC and over a third of patients had serious complications including major haemorrhage, collapse and microangiopathy. The results of this study support accumulating evidence that giving more than one vial of antivenom is unnecessary in brown snake envenoming.",
    keywords = "snake venom antiserum, abdominal pain, adolescent, adult, aged, anaphylaxis, article, Australia, bleeding, brain hemorrhage, cardiovascular disease, child, collapse, controlled study, death, diaphoresis, diarrhea, disseminated intravascular clotting, envenomation, enzyme immunoassay, female, headache, heart arrest, human, hypotension, international normalized ratio, major clinical study, male, mortality, nausea, neurotoxicity, observational study, preschool child, prospective study, Pseudonaja, Pseudonaja textilis, ptosis, school child, snake, snakebite, symptomatology, thrombocytopenia, thrombotic thrombocytopenic purpura, vomiting, Adolescent, Adult, Aged, Aged, 80 and over, Animals, Antivenins, Child, Child, Preschool, Elapid Venoms, Elapidae, Female, Humans, Male, Middle Aged, Prospective Studies, Snake Bites, Serpentes, Storeria dekayi",
    author = "G Allen and Simon Brown and Nicholas Buckley and Margaret O'Leary and Page, {Colin B} and Bart Currie and Julian White and Geof Isbister",
    year = "2012",
    doi = "10.1371/journal.pone.0053188",
    language = "English",
    volume = "7",
    pages = "1--9",
    journal = "PLoS One",
    issn = "1932-6203",
    publisher = "Public Library of Science (PLoS)",
    number = "12",

    }

    Clinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja spp.) Envenoming - Australian Snakebite Project (ASP-14). / Allen, G; Brown, Simon; Buckley, Nicholas; O'Leary, Margaret; Page, Colin B; Currie, Bart; White, Julian; Isbister, Geof.

    In: PLoS One, Vol. 7, No. 12, e53188, 2012, p. 1-9.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Clinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja spp.) Envenoming - Australian Snakebite Project (ASP-14)

    AU - Allen, G

    AU - Brown, Simon

    AU - Buckley, Nicholas

    AU - O'Leary, Margaret

    AU - Page, Colin B

    AU - Currie, Bart

    AU - White, Julian

    AU - Isbister, Geof

    PY - 2012

    Y1 - 2012

    N2 - Background: Snakebite is a global health issue and treatment with antivenom continues to be problematic. Brown snakes (genus Pseudonaja) are the most medically important group of Australian snakes and there is controversy over the dose of brown snake antivenom. We aimed to investigate the clinical and laboratory features of definite brown snake (Pseudonaja spp.) envenoming, and determine the dose of antivenom required.Methods and Finding: This was a prospective observational study of definite brown snake envenoming from the Australian Snakebite Project (ASP) based on snake identification or specific enzyme immunoassay for Pseudonaja venom. From January 2004 to January 2012 there were 149 definite brown snake bites [median age 42y (2–81y); 100 males]. Systemic envenoming occurred in 136 (88%) cases. All envenomed patients developed venom induced consumption coagulopathy (VICC), with complete VICC in 109 (80%) and partial VICC in 27 (20%). Systemic symptoms occurred in 61 (45%) and mild neurotoxicity in 2 (1%). Myotoxicity did not occur. Severe envenoming occurred in 51 patients (38%) and was characterised by collapse or hypotension (37), thrombotic microangiopathy (15), major haemorrhage (5), cardiac arrest (7) and death (6). The median peak venom concentration in 118 envenomed patients was 1.6 ng/mL (Range: 0.15–210 ng/mL). The median initial antivenom dose was 2 vials (Range: 1–40) in 128 patients receiving antivenom. There was no difference in INR recovery or clinical outcome between patients receiving one or more than one vial of antivenom. Free venom was not detected in 112/115 patients post-antivenom with only low concentrations (0.4 to 0.9 ng/ml) in three patients.Conclusions: Envenoming by brown snakes causes VICC and over a third of patients had serious complications including major haemorrhage, collapse and microangiopathy. The results of this study support accumulating evidence that giving more than one vial of antivenom is unnecessary in brown snake envenoming.

    AB - Background: Snakebite is a global health issue and treatment with antivenom continues to be problematic. Brown snakes (genus Pseudonaja) are the most medically important group of Australian snakes and there is controversy over the dose of brown snake antivenom. We aimed to investigate the clinical and laboratory features of definite brown snake (Pseudonaja spp.) envenoming, and determine the dose of antivenom required.Methods and Finding: This was a prospective observational study of definite brown snake envenoming from the Australian Snakebite Project (ASP) based on snake identification or specific enzyme immunoassay for Pseudonaja venom. From January 2004 to January 2012 there were 149 definite brown snake bites [median age 42y (2–81y); 100 males]. Systemic envenoming occurred in 136 (88%) cases. All envenomed patients developed venom induced consumption coagulopathy (VICC), with complete VICC in 109 (80%) and partial VICC in 27 (20%). Systemic symptoms occurred in 61 (45%) and mild neurotoxicity in 2 (1%). Myotoxicity did not occur. Severe envenoming occurred in 51 patients (38%) and was characterised by collapse or hypotension (37), thrombotic microangiopathy (15), major haemorrhage (5), cardiac arrest (7) and death (6). The median peak venom concentration in 118 envenomed patients was 1.6 ng/mL (Range: 0.15–210 ng/mL). The median initial antivenom dose was 2 vials (Range: 1–40) in 128 patients receiving antivenom. There was no difference in INR recovery or clinical outcome between patients receiving one or more than one vial of antivenom. Free venom was not detected in 112/115 patients post-antivenom with only low concentrations (0.4 to 0.9 ng/ml) in three patients.Conclusions: Envenoming by brown snakes causes VICC and over a third of patients had serious complications including major haemorrhage, collapse and microangiopathy. The results of this study support accumulating evidence that giving more than one vial of antivenom is unnecessary in brown snake envenoming.

    KW - snake venom antiserum

    KW - abdominal pain

    KW - adolescent

    KW - adult

    KW - aged

    KW - anaphylaxis

    KW - article

    KW - Australia

    KW - bleeding

    KW - brain hemorrhage

    KW - cardiovascular disease

    KW - child

    KW - collapse

    KW - controlled study

    KW - death

    KW - diaphoresis

    KW - diarrhea

    KW - disseminated intravascular clotting

    KW - envenomation

    KW - enzyme immunoassay

    KW - female

    KW - headache

    KW - heart arrest

    KW - human

    KW - hypotension

    KW - international normalized ratio

    KW - major clinical study

    KW - male

    KW - mortality

    KW - nausea

    KW - neurotoxicity

    KW - observational study

    KW - preschool child

    KW - prospective study

    KW - Pseudonaja

    KW - Pseudonaja textilis

    KW - ptosis

    KW - school child

    KW - snake

    KW - snakebite

    KW - symptomatology

    KW - thrombocytopenia

    KW - thrombotic thrombocytopenic purpura

    KW - vomiting

    KW - Adolescent

    KW - Adult

    KW - Aged

    KW - Aged, 80 and over

    KW - Animals

    KW - Antivenins

    KW - Child

    KW - Child, Preschool

    KW - Elapid Venoms

    KW - Elapidae

    KW - Female

    KW - Humans

    KW - Male

    KW - Middle Aged

    KW - Prospective Studies

    KW - Snake Bites

    KW - Serpentes

    KW - Storeria dekayi

    U2 - 10.1371/journal.pone.0053188

    DO - 10.1371/journal.pone.0053188

    M3 - Article

    VL - 7

    SP - 1

    EP - 9

    JO - PLoS One

    JF - PLoS One

    SN - 1932-6203

    IS - 12

    M1 - e53188

    ER -