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AnimalPoisons
InjectedToxins
“SnakeBites
ScorpionStings
Toxicological ..Clinical Approach”
By:
AhmedEssamFarrag
4thYearMedicalStudent
MansouraFacultyofMedicine-Egypt
Epidemiology
Epidemiology
Only5%to10%
ofsnakebitesInvolve VenomousSnakes
InEgypt, VenomousSnakesbelongtoFamilies:
Elapidae
Viperidae
Hydrophidae
Acommonsymptomofabitefromavenomoussnakeisthe
presenceoftwopuncturewounds fromtheanimal'sfangs..
Snake venom is highly modified saliva
containing zootoxins which facilitates the
immobilization and digestion of prey, and
defends against threats. It is injected by unique
fangs after a bite, and some species are also able
tospit..
Venomdeliveryapparatus
Venom:FaintTransparentyellow,Viscous
NeurotoxicVenom
• Curare –like
Action
• Causing
paralysis of
motor nerve
endings in
voluntary
muscles .
VasculotoxicVenom
• Contains
phospholipase
enzyme
• Produce
destruction of
RBCs leading
to Hemolysis
and
coagualtive
Disorders .
MyotoxicVenom
• Produces
Generalized
Muscular Pain
and Weakness
• Then,
Degeneration
of Muscles
and
Myoglobinuria
which may
cause
respiratory,
renal failure .
Abiteisconsidered tohavebeen poisonousincaseanyofthe
following featuresarepresent:
• Swelling,blisteringornecrosisatthesiteofthebite
• Hypotension/shock
• Haemorrhage
• Laboratoryevidenceofcoagulationdefect
• Neuroparalyticmanifestations
• Arrhythmias/bradycardia/tachycardia
• Myoglobinuria
ElapidSnakeBite(Neurotoxic) ViperSnakeBite(Vasculotoxic) SeaSnakeBite(Myotoxic)
Local
Mild orMinimal Swelling and
Inflammationaround theFangMarks
Severelocalpain,Erythema,
Hemorrhagicblebs,
Oozingofhemolyticbloodand
blisters
Mildor Minimal Swelling and
Inflammation around the FangMarks
Systemic
Nausea,Vomiting,Salivation
Ptosis (1st NeuroSign), Squint
Dysartheria, Dysphonia, Dysphagia
confusion, lethargy, MS Weakness
Descending Paralysis
Slow, labored breathing
Cobra VenomOphthalmia
Nausea,Vomiting
Weakness,MSFasciculations
HypovolemicShock
LocalCompartmentSyndrome
DeathfromCirculatoryCollapse
StiffnessoftheNeck
GeneralizedMSWeakness
RespiratoryDistress
Myoglobinuria(BrownUrine)
Hyperkalemia
ClinicalPresentation
FirstAid
Reassuranceand
CloseMonitoring
Emergencyand
SupportiveMeasures
Antivenin
Management
contain specific antibody that will neutralize that
particular venom and perhaps the venoms of closely
relatedspecies(paraspecificneutralization)
Antivenin
Antivenom should be given only to
patients in whom its benefits are
considered likely to exceed its risks.
Since antivenom is relatively costly
and often in limited supply, it should
not be used indiscriminately. The risk
of reactions should always be taken
intoconsideration
Classification
RED : Very Toxic
YELLOW : Toxic
Black : Non Toxic
Scorpionstingsarepainful
butrarelylife-threatening.
Youngchildren,and
sometimestheveryold,are
mostatriskofserious
complications..
ClinicalPresentation
Signsandsymptomsatthesiteofthestingmayinclude:
• Pain,whichcanbeintense
• Numbnessandtinglingintheareaaroundthesting
• Slightswellingintheareaaroundthesting
ClinicalPresentation
Signsandsymptoms relatedtowidespread(systemic) venomeffectsusuallyoccurin
childrenwhoarestung andmayinclude:
• Difficulty breathing
• Muscle twitching orthrashing
• Unusual head,neckandeyemovements
• Drooling
• Sweating
• Nausea andvomiting
• High bloodpressure(hypertension)
• Accelerated heartrate (tachycardia)orirregular heartbeat (arrhythmia)
• Restlessness orexcitability orinconsolable crying(inchildren)
FirstAid
• Cleanthewoundwithmildsoapandwater.
• Apply a cool compress to the affected area for
10 minutes. Remove it for 10 minutes, then
reapply it. This helps reduce pain and slow
the venom's spread. This is most effective in
thefirsttwohoursafterastingoccurs.
Reassuranceand
Sedation
Emergencyand
SupportiveMeasures
Antivenom
Management
Preparedfromgoatsinadoseof5Ampoules..
IntravenouslytoPatientWithSerious
ManifestationsWouldReverseNeuralgic
SymptomsWithinMinutestoanHour
Antivenom
TakeHomeMessage
Bites and stings by venomous animals constitute
emergencies. Without fast, competent
treatment they can result in considerable injury
andaresometimesfatal.
ThankYou..

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Snake bite .. scorpion sting