Escolar Documentos
Profissional Documentos
Cultura Documentos
By
Muhamad Rusdi Ahmad Rusmili B.Pharm (Hons), Ph.D
Department of Basic Medical Sciences
Kulliyyah of Pharmacy
International Islamic University Malaysia
Kuantan Campus, Pahang, Malaysia
Outcome of the presentation
• Explanation on snake bite and snake envenoming
• The medically important snake species with prominent neurotoxic
activity
• The common neurotoxic syndromes caused by snake envenoming
• Brief introduction on the types of neurotoxins
• Venom variation and its effects on the management of snake
envenoming
Snake bite Vs Snake Envenoming
• Snake bite ≠ Snake envenoming
• Non-venomous/mildly venomous snake can bite but
without significant effect
• Python bite can cause serious laceration but not
envenoming ( constrictors are known to hunt, kill and
eat human!!!! ) A man was eaten by a reticulated python in
• Not all snake bite is caused by venomous snake species Perak, Malaysia
*Picture adapted from Dr. Khaldun’s Snakebite and Envenomation Management in Malaysia
Snake families and general venom effects
Venomous
Snake families
An elapid A viperid
Australasian snake
species
Brown snake
Pseudonaja spp
Taipan
Oxyuranus spp
Medically important venomous species with
dominant neurotoxic activity in Indonesia
• After Wallace line
Ikaheka snake
Death adder
Micropechis ikaheka
Acanthophis spp
Available in Malaysia and
Unique to Indonesia Unique to Malaysia
Indonesia
12:00:20.000 AM
Control/not neurotoxic
6
Channel 4 (g)
ach
cch
cch
-0 7
kcl
kcl
1
12:26:37.750 AM
10:00
2
20:00
3
30:00 40:00 50:00 1:00:00 1:10:00 1:20:00 1:30:00 1:40:00 1:50:00
Chick_BCPostRusdi_NawalScorpie041012(1)_myotox
2:00:00 2:10:00 2:20:00 2:30:00 2:40:00 2:50:00 3:00:00
11
3:10:00
12
3:20:00
13
2
1ug/ml alpha-bungarotoxin
0
stimulation
ach
ach
cch
cch
ckl
kcl
3 4 8 11 22 26 28
30:00 40:00 50:00 1:00:00 1:10:00 1:20:00 1:30:00 1:40:00 1:50:00 2:00:00 2:10:00 2:20:00 2:30:00 2:40:00 2:50:00 3:00:00
Chick_100713(2)
12:09:10.000 AM
6
4 Presynaptic neurotoxin
Channel 4 (g)
2
0.1ug/ml BF B-btx
0
cch
ach
ach
cch
3 11
kcl
kcl
20:00 40:00 1:00:00 1:20:00 1:40:00 2:00:00 2:20:00 2:40:00 3:00:00 3:20:00 3:40:00 4:00:00 4:20:00 4:40:00 5:00:00
2 4 5 14 15 16
Specific Objectives
• To re-examined the neurotoxicity of the venoms by
using chick biventer
• To test the efficacy of monovalent antivenoms and
Neuro Polyvalent antivenom
Specific Methodology
Add
Ach, CCh, KCl
Add
Antivenom
% C h a n g e f r o m in it ia l t w it c h h e ig h t
% C h a n g e f r o m in it ia l t w it c h h e ig h t
120
250
100 V e h ic le c o n tr o l V e h ic le c o n tr o l
1 g /m l B C 200 1 g /m l B C
80 1 0 u /m l B C
1 0 g /m l B C 150
60 T90 =13 min 100
40
20
T90 = 61 min 50
* * * *
* * 0
0
l
h
C
C
K
A
C
0 20 40 60 80 100
T im e ( m in )
% C h a n g e f r o m in it ia l t w it c h h e ig h t
% C h a n g e f r o m in it ia l t w it c h h e ig h t
120 250
V e h ic le c o n tr o l V e h ic le c o n tr o l
100 200 1 g /m l B F
1 g /m l B F
1 0 g /m l B F
80 1 0 g /m l B F 150
40 50
20
T90 = 62 min * * * *
0
* *
l
h
C
0
K
C
C
A
0 20 40 60
T im e ( m in )
80 100
There are nAChR receptors that are not
blocked
Neutralization by monovalent antivenoms
% C h a n g e fr o m in itia l tw itc h h e ig h t
100
*
80
* 1 0 g /m l B F
60 1 0 g /m l B F + 1 x B F A V
1 0 g /m l B F + 3 x B F A V
40
1 0 g /m l B F + 5 x B F A V
% C h a n g e fr o m in itia l tw itc h h e ig h t
Neurotoxicity by the
100
* venoms was attenuated by
80 prior tissue incubation with
recommended dose of
60 1 0 g /m l B C
1 0 g /m l B C + 1 x N P V
antivenoms (1x) and
40
1 0 g /m l B C + 3 X N P V prevented by incubation
20
with higher dose (3x) of
polyvalent antivenom
0
0 20 40 60 80 100
T im e ( m in )
% C h a n g e fr o m in itia l tw itc h h e ig h t
100
1 0 g /m l B F
* 1 0 u g /m l B F + 1 x N P V
1 0 u g /m l B F + 3 X N P V
50
100
1 0 g /m l B C tissue incubation with
1 0 g /m B F higher dose (3x) of
80
1 0 g /m l B C v s 3 x B F A V
different species
monovalent antivenom
60 1 0 g /m l B F v s 3 x B C A V
40
20
0
0 10 20 30
T im e ( m in )
Addition of monovalent antivenoms at t90 for both venoms did not reverse
neurotoxicity. However, addition of polyvalent antivenom at t90 partially
reversed neurotoxicity caused by B.fasciatus but not B.candidus
Important messages from the presentation
• A snake bite is not necessarily a snake envenoming
• Neurotoxicity is one of the symptoms of snake envenoming
• Neurotoxicity can be caused by types of toxin
• Presynaptic
• Postsynaptic
• Know the local snake species
• Get your pharmacist to buy/stock the correct antivenom
• Use the correct antivenom
• Give antivenom as soon as possible
Acknowledgement