NATIONAL UNIVERSITY OF

ADVANCED LEGAL STUDIES

Medical Jurisprudence Project

ANIMAL TOXINS



Shazia Bint Ashraf
Roll no. 624
8
th
Semester



SNAKE BITE

Snake bite is common life-threatening in many countries. Farmers, hunters, rice-
pickers are at particular risk. Prompt medical treatment is vital. 3-5 million victims
/year, 50 000 deaths, 400 000 amputations. 40% of bites do not produce signs of
envenoming. It is difficult to predict which bites will produce symptoms or the
clinical outcome; all victims should be brought under medical care as quickly as
possible. Poisonous species of snake fall into the families. Snake venoms are
complex mixtures of proteins & small polypeptides with enzymatic activity. Snake
venoms are neurotoxins, haematotoxins (haemorrhagic or coagulopathic) or
cardiotoxins etc.

Characteristic Poisonous Non-poisonous
a. Shape of head triangular round
b. Pit (+) (-)
c. Pupils elliptical Round
d. Bite marks Fang marks 2 rows of teeth
e. Caudal plates Single row Double row
f. Color body
Red ring next to yellow
(coral snakes)
Alternating color


The venom is detected from a dry swab of the bite site using monoclonal antibody
techniques. The 20-minute whole blood-clotting test is a useful bedside tool in
remote areas; a 2-3 ml sample of venous blood from the victim is left undisturbed at
ambient temperature for at least 20 minutes. The vessel containing the blood is then
tipped once & may be compared with a normal control. If it has not clotted, there is
haemostatic disturbance from systemic envenoming. All patients should have a full
blood count, urea/electrolytes, liver function tests, creatine kinase, troponins, ECG.

EFFECTS OF DIFFERENT TYPES OF TOXINS




MANAGEMENT OF SNAKE BITES
Reassuring the patient
Immobilizing the bitten area to minimize venom spread
Identifying the snake.
Application of a firm bandage to occlude lymphatic drainage is appropriate,
but tourniquets are unhelpful since they do not prevent the spread of venom &
frequently applied incorrectly.
Incisions at the bite site &attempts to suck out the venom by mouth should
not be made.
A large-bore IV cannula inserted on an unaffected limb.
BP, coagulation, renal, neurological, cardio respiratory status must be
monitored, as hypotension, anaphylactic shock, renal failure, respiratory
distress may develop rapidly.
All patients with suspected envenoming should be observed for 12-24 hours,
as the initial manifestations may be delayed, especially with elapid bites.
Pain/vomiting should be managed symptomatically.
Aspirin should not be used, it may aggravate bleeding.
In severe coagulopathy with thrombocytopenia causing DIC, large quantities
of fresh frozen plasma, cryoprecipitate , platelets are required if the response
to antivenin is poor.
The most appropriate therapy is timely administration of the species-
appropriate antivenin when indications.
Before starting antivenin, ask about history of allergy & intradermal sensitivity
test performed by injecting 0.02 ml of saline-diluted antiserum at a site
distant from the bite.
The injured site is observed for at least 10 minutes for the redness, hives,
pruritus or other adverse effects.


The shorter the interval between injured & reaction, the greater the degree of
sensitivity.
0.5 ml 1:1000 adrenaline must be available when antivenin given
A negative skin test does not rule out a reaction following administration of
the full antivenin dose.
The rate antivenin should be based on the severity of the case& the patient's
tolerance to the antivenin.
The entire initial dose should be given as soon as possible within 4 hours of
the bite.
In severe envenoming, antivenin given up to 24 hours after the bite has been
shown to reverse coagulation deficits.



SPIDER BITES
I. Lactrodectus spiders (Black Widow)
Worldwide
female: black color w/ a distinctive red ventral marking w/ hourglass
shape
Nocturnal spider; bites defensively
Has neurotoxin venom
Act at presynaptic terminal
Enhance neurotransmitter release
Acetylcholine = neuromuscular junction (muscle spasm)
Norepinephrine = produces adrenergic stimulation

Manifestation:
Erythema & pain at bite site
Neuromuscular symptoms (30mins)
Severe pain & spasm of large muscle group
1. Abdominal cramps
2. Dyspnea (chest tightness)
Adrenergic stimulation:
1. HPN / diaphoresis / tachycardia
2. Fasciculation / Nausea/vomiting
3. Headache / paresthesia / fatigue / salivation
Acute symptoms peak several hours & resolve in 1-2 days
Death unusual
Treatment:
a. Mild envenomation
Local wound care:


Clean the site
Apply ice to alleviate pain
tetanus prophylaxis
b. Severe envenomation
- IV calcium gluconate (transient effect)
- Narcotic & benzodiazepine - relieve muscle pain
- Antivenin (horse serum) reserve for severe envenomation due
to anaphylaxis & serum sickness (side effect)
- Antivenum is recommended:
Pregnant women
Children under 16 yrs
Patients w/ severe reaction:
a. Uncontrolled HPN
b. Respiratory distress
c. Seizures
- Skin testing = if (+) should. Receive pretx w/ diphenhydramine.
- Recommended antivenin dose = 1 vial, repeated as necessary



SCORPION STINGS

Scorpions are the most important venomous animals after snakes. Most scorpion
species produce venom which causes only minor local reactions in humans, but in
Mexico, Tunisia, Algeria, Morocco, Libya scorpion stings are a serious health hazard.
Scorpions do not attack humans & escape when disturbed. Stings occur after a
person accidentally steps on or involuntarily presses the scorpion (when it is trapped
inside shoes or clothes) or when reaching under dead wood or stones. Clothes / shoes
need to be inspected closely & shaken& sitting or sleeping places checked when
camping in rural districts where scorpions are common.
Some scorpions have neurotoxins that prevent sodium channel closure. Cranial
nerves & neuromuscular dysfunction are caused which result in respiratory distress
in the bite victim.
Treatment:
Local:
Ice pack therapy / analgesic -> for pain
Tetanus prophylaxis
Systemic:
Monitor closely cardiovascular & respiratory status in ICU
Antivenin can reverses cranial nerve & neuromuscular symptoms but can
cause anaphylaxis & delayed serum sickness



BEE STINGS
The term bee here, includes Honeybee, bumble bee, black hornet etc. their
venom is administered drop by drop similar to a rattle snake. The bees have a barb-
shaped stinger.
Venom: Histamine/serotonin (local reaction & pain)
Causes tissue necrosis, Phospholipase/hyaluronidase, destroys collagen and is also
an allergen.

Manifestation
Local reaction:
Sting produced localize pain, wheal which results in a pustule.
20% produced large local reaction as erythematous, edematous, and painful and
pruritic areas larger than 10cm. This may last for up to 2-5 days.
Represents combination of IgE mediated, cell mediated problems.
Systemic reaction:
Multiple stings can produce toxic reactions.
1. Vomiting, diarrhea, generalized edema
2. Cardiovascular collapse
3. Hemolysis
3% causes death due to anaphylaxis w/in 1 hr.
Starts as urticaria then proceeds to angioedema, respiratory arrest 2
nd
to airway
edema and cardiovascular collapse.




Treatment:
Local therapy:
Removal of sting (gentle scraping)
Clean the site
Pain: - apply ice
- Vinegar
- Topical or injected lidocaine
Pruritus: - antihistamine
Larger area: elevate the site
- Analgesia
- Prednisone (1mg/k/day)
Systemic therapy:
Mild anaphylaxis:
Epinephrine
Oral or IV antihistamine
Severe anaphylaxis:
IV - endotracheal intubation
Vasopressor - steroid
Bronchodilator - ICU monitoring



Venomous Aquatic Animals
Invertebrates
1. Coelenterates: (Jelly fish)
Venomous stinging cells called nematocyte
Mild envenomation:
- Sting produces skin irritation
1. Pruritus, paresthesia & throbbing pain
2. Edema and erythema ----> blisters & petechia ----> local
infection & ulceration.
Treatment:
Clean the wound w/ sea water
Apply diluted 5% acetic acid (vinegar) or baking soda; it can
inactivate the toxin; applied for 30 minutes or until the pain is relieved
After wound irrigation ---> remaining nematocyst are removed by
applying shaving cream and shave the area w/ razor
Local anesthesia, antihistamine or steroids can relieve pain after the
toxin is inactivated.
Prophylactic antibiotic are usually unnecessary

2. Echinodermata (sea urchins & sea cucumber)
Causes contact dermatitis
Sea cucumbers feeds on coelenterates and secrete nematocytes hence
local therapy for coelenterates should be done
Sea urchins venomous spines causing local & systemic reaction like
coelenterates


Treatment:
Soak w/ hot water
Spines of the organism located w/ x-ray or MRI and should be removed
Swelling alleviated w/ steroids

3. Mollusks (octopus):
Can bite & inject tetrodoxine (paralytic agent)
pressure & immobilize to contain venom
Systemic complication --- supportive

Vertebrates
1. Stingrays:
Whiplike appendages with spines at its end that can produce puncture
wounds & lacerations
Venom = vasoconstrictions causing cyanosis of wound ---->
myonecrosis
Systemic reaction:
1. Cardiac arrhythmia
2. Respiratory arrest
3. seizures
Treatment:
Wound irrigated and soaked w/water for an hour
Debridement, exploration and removal of spines


Wound is elevated, dressed and not closed primarily
Pain relieved locally and systemically
2. Sea Snakes: (Hydrophiidae)
Neurologic sign and symptoms
Death is due to paralysis and resp. arrest
Toxin similar to coral snake
Pressure, immobilize technique
Antivenin administration 1 ampule initially then repeated as
needed