Clinical effects of red-bellied black snake (Pseudechis porphyracus) envenoming and correlation with venom concentrations

Australian Snakebite Project (ASP-11)

Andrew Churchman, Margaret O'Leary, Nicholas Buckley, Colin B Page, Alan Tankel, Chris Gavaghan, Anna Holdgate, Simon Brown, Geoffrey Isbister

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Objective: To describe the clinical features and laboratory findings in patients with definite red-bellied black snake (RBBS; Pseudechis porphyriacus) bites, including correlation with results of venom assays.

    Design, patients and setting: Prospective cohort study of patients with definite RBBS bites, recruited to the Australian Snakebite Project from January 2002 to June 2010.

    Main outcome measures: Clinical and laboratory features of envenoming; peak venom concentrations and antivenom treatment.

    Results:
    There were 81 definite RBBS bites; systemic envenoming occurred in 57 patients (70%) and local envenoming alone occurred in one patient. Systemic envenoming was characterised by local envenoming in 55 patients (96%), systemic symptoms in 54 patients (95%), anticoagulant coagulopathy with a raised activated partial thromboplastin time (aPTT) in 35 patients (61%) and myotoxicity in seven patients (12%). One patient required non-invasive ventilation for severe myotoxicity that resulted in muscle weakness. Three patients developed local ulceration. There were no deaths. Twenty-two envenomed patients (39%) received tiger snake or black snake antivenom, and administration within 6 hours of the bite was associated with normalisation of the aPTT. Eight patients (36%) had immediate hypersensitivity reactions to antivenom, including one case of anaphylaxis. The median peak venom concentration in 37 systemically envenomed patients with serum available was 19 ng/mL (interquartile range, 12–50 ng/mL; range, 3–360 ng/mL), which did not correlate with clinical severity. In 17 patients who received antivenom and had venom concentration measured, no venom was detected in serum after the first antivenom dose, including nine who were given one vial of tiger snake antivenom.

    Conclusion: RBBS envenoming caused local effects, systemic symptoms, anticoagulant coagulopathy and, uncommonly, myotoxicity. One vial of tiger snake or black snake antivenom appears to be sufficient to remove venom and neutralise reversible effects, but hypersensitivity reactions occurred in over a third of patients.
    Original languageEnglish
    Pages (from-to)696-700
    Number of pages5
    JournalMedical Journal of Australia
    Volume193
    Issue number11/12
    Publication statusPublished - 6 Dec 2010

    Fingerprint

    Snake Bites
    Snakes
    Venoms
    Antivenins
    Bites and Stings
    Partial Thromboplastin Time
    Anticoagulants
    Noninvasive Ventilation
    Immediate Hypersensitivity
    Muscle Weakness
    Anaphylaxis

    Cite this

    Churchman, A., O'Leary, M., Buckley, N., Page, C. B., Tankel, A., Gavaghan, C., ... Isbister, G. (2010). Clinical effects of red-bellied black snake (Pseudechis porphyracus) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP-11). Medical Journal of Australia, 193(11/12), 696-700.
    Churchman, Andrew ; O'Leary, Margaret ; Buckley, Nicholas ; Page, Colin B ; Tankel, Alan ; Gavaghan, Chris ; Holdgate, Anna ; Brown, Simon ; Isbister, Geoffrey. / Clinical effects of red-bellied black snake (Pseudechis porphyracus) envenoming and correlation with venom concentrations : Australian Snakebite Project (ASP-11). In: Medical Journal of Australia. 2010 ; Vol. 193, No. 11/12. pp. 696-700.
    @article{c13b706ef72f443cbedd183638797d2a,
    title = "Clinical effects of red-bellied black snake (Pseudechis porphyracus) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP-11)",
    abstract = "Objective: To describe the clinical features and laboratory findings in patients with definite red-bellied black snake (RBBS; Pseudechis porphyriacus) bites, including correlation with results of venom assays.Design, patients and setting: Prospective cohort study of patients with definite RBBS bites, recruited to the Australian Snakebite Project from January 2002 to June 2010.Main outcome measures: Clinical and laboratory features of envenoming; peak venom concentrations and antivenom treatment.Results: There were 81 definite RBBS bites; systemic envenoming occurred in 57 patients (70{\%}) and local envenoming alone occurred in one patient. Systemic envenoming was characterised by local envenoming in 55 patients (96{\%}), systemic symptoms in 54 patients (95{\%}), anticoagulant coagulopathy with a raised activated partial thromboplastin time (aPTT) in 35 patients (61{\%}) and myotoxicity in seven patients (12{\%}). One patient required non-invasive ventilation for severe myotoxicity that resulted in muscle weakness. Three patients developed local ulceration. There were no deaths. Twenty-two envenomed patients (39{\%}) received tiger snake or black snake antivenom, and administration within 6 hours of the bite was associated with normalisation of the aPTT. Eight patients (36{\%}) had immediate hypersensitivity reactions to antivenom, including one case of anaphylaxis. The median peak venom concentration in 37 systemically envenomed patients with serum available was 19 ng/mL (interquartile range, 12–50 ng/mL; range, 3–360 ng/mL), which did not correlate with clinical severity. In 17 patients who received antivenom and had venom concentration measured, no venom was detected in serum after the first antivenom dose, including nine who were given one vial of tiger snake antivenom.Conclusion: RBBS envenoming caused local effects, systemic symptoms, anticoagulant coagulopathy and, uncommonly, myotoxicity. One vial of tiger snake or black snake antivenom appears to be sufficient to remove venom and neutralise reversible effects, but hypersensitivity reactions occurred in over a third of patients.",
    author = "Andrew Churchman and Margaret O'Leary and Nicholas Buckley and Page, {Colin B} and Alan Tankel and Chris Gavaghan and Anna Holdgate and Simon Brown and Geoffrey Isbister",
    year = "2010",
    month = "12",
    day = "6",
    language = "English",
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    pages = "696--700",
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    Churchman, A, O'Leary, M, Buckley, N, Page, CB, Tankel, A, Gavaghan, C, Holdgate, A, Brown, S & Isbister, G 2010, 'Clinical effects of red-bellied black snake (Pseudechis porphyracus) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP-11)', Medical Journal of Australia, vol. 193, no. 11/12, pp. 696-700.

    Clinical effects of red-bellied black snake (Pseudechis porphyracus) envenoming and correlation with venom concentrations : Australian Snakebite Project (ASP-11). / Churchman, Andrew; O'Leary, Margaret; Buckley, Nicholas; Page, Colin B; Tankel, Alan; Gavaghan, Chris; Holdgate, Anna; Brown, Simon; Isbister, Geoffrey.

    In: Medical Journal of Australia, Vol. 193, No. 11/12, 06.12.2010, p. 696-700.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Clinical effects of red-bellied black snake (Pseudechis porphyracus) envenoming and correlation with venom concentrations

    T2 - Australian Snakebite Project (ASP-11)

    AU - Churchman, Andrew

    AU - O'Leary, Margaret

    AU - Buckley, Nicholas

    AU - Page, Colin B

    AU - Tankel, Alan

    AU - Gavaghan, Chris

    AU - Holdgate, Anna

    AU - Brown, Simon

    AU - Isbister, Geoffrey

    PY - 2010/12/6

    Y1 - 2010/12/6

    N2 - Objective: To describe the clinical features and laboratory findings in patients with definite red-bellied black snake (RBBS; Pseudechis porphyriacus) bites, including correlation with results of venom assays.Design, patients and setting: Prospective cohort study of patients with definite RBBS bites, recruited to the Australian Snakebite Project from January 2002 to June 2010.Main outcome measures: Clinical and laboratory features of envenoming; peak venom concentrations and antivenom treatment.Results: There were 81 definite RBBS bites; systemic envenoming occurred in 57 patients (70%) and local envenoming alone occurred in one patient. Systemic envenoming was characterised by local envenoming in 55 patients (96%), systemic symptoms in 54 patients (95%), anticoagulant coagulopathy with a raised activated partial thromboplastin time (aPTT) in 35 patients (61%) and myotoxicity in seven patients (12%). One patient required non-invasive ventilation for severe myotoxicity that resulted in muscle weakness. Three patients developed local ulceration. There were no deaths. Twenty-two envenomed patients (39%) received tiger snake or black snake antivenom, and administration within 6 hours of the bite was associated with normalisation of the aPTT. Eight patients (36%) had immediate hypersensitivity reactions to antivenom, including one case of anaphylaxis. The median peak venom concentration in 37 systemically envenomed patients with serum available was 19 ng/mL (interquartile range, 12–50 ng/mL; range, 3–360 ng/mL), which did not correlate with clinical severity. In 17 patients who received antivenom and had venom concentration measured, no venom was detected in serum after the first antivenom dose, including nine who were given one vial of tiger snake antivenom.Conclusion: RBBS envenoming caused local effects, systemic symptoms, anticoagulant coagulopathy and, uncommonly, myotoxicity. One vial of tiger snake or black snake antivenom appears to be sufficient to remove venom and neutralise reversible effects, but hypersensitivity reactions occurred in over a third of patients.

    AB - Objective: To describe the clinical features and laboratory findings in patients with definite red-bellied black snake (RBBS; Pseudechis porphyriacus) bites, including correlation with results of venom assays.Design, patients and setting: Prospective cohort study of patients with definite RBBS bites, recruited to the Australian Snakebite Project from January 2002 to June 2010.Main outcome measures: Clinical and laboratory features of envenoming; peak venom concentrations and antivenom treatment.Results: There were 81 definite RBBS bites; systemic envenoming occurred in 57 patients (70%) and local envenoming alone occurred in one patient. Systemic envenoming was characterised by local envenoming in 55 patients (96%), systemic symptoms in 54 patients (95%), anticoagulant coagulopathy with a raised activated partial thromboplastin time (aPTT) in 35 patients (61%) and myotoxicity in seven patients (12%). One patient required non-invasive ventilation for severe myotoxicity that resulted in muscle weakness. Three patients developed local ulceration. There were no deaths. Twenty-two envenomed patients (39%) received tiger snake or black snake antivenom, and administration within 6 hours of the bite was associated with normalisation of the aPTT. Eight patients (36%) had immediate hypersensitivity reactions to antivenom, including one case of anaphylaxis. The median peak venom concentration in 37 systemically envenomed patients with serum available was 19 ng/mL (interquartile range, 12–50 ng/mL; range, 3–360 ng/mL), which did not correlate with clinical severity. In 17 patients who received antivenom and had venom concentration measured, no venom was detected in serum after the first antivenom dose, including nine who were given one vial of tiger snake antivenom.Conclusion: RBBS envenoming caused local effects, systemic symptoms, anticoagulant coagulopathy and, uncommonly, myotoxicity. One vial of tiger snake or black snake antivenom appears to be sufficient to remove venom and neutralise reversible effects, but hypersensitivity reactions occurred in over a third of patients.

    M3 - Article

    VL - 193

    SP - 696

    EP - 700

    JO - Medical Journal of Australia

    JF - Medical Journal of Australia

    SN - 0025-729X

    IS - 11/12

    ER -