Clinical Toxicology

Animal Poisoning

7th June 2021

4th Year Clinical Toxicology
Department of Pharmacy
School of Health Sciences
UNZA
8th Lecture

Andrew M Bambala
bambalaandrew@gmail.com

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 Introduction:

Envenomation is the process by which venom is injected by the bite or sting of a

venomous animal.

Envenomation's caused by animal poisons are common toxicological emergencies.

Common animals causing envenomation include:

• Reptiles Snakes and lizards.

• Arthropods e.g. scorpions, spiders, ticks, bees and ants

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 Envenomation by animal venoms:

• All animal venoms are mixtures of proteins and enzymes with various actions that affect

most body systems.

• Accidents predominate in summer, rare in winter (hibernation).

• The onset of symptoms and the clinical picture are variable as they depend on many
factors like the amount and type of injected venom, the age, size and medical state of the
victim,…..etc.

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 Envenomation by animal venoms:
• Prognosis: the condition is always severe in young and aged victims (infants and young
children)

• When bites or stings are produced in a central location (neck, back,face) and

when victims receive more than one bite or sting

• Diagnosis: consists of history, local and systemic manifestations as well as investigations.

• Treatment: consists of local treatment, antivenom and treatment of symptoms

and complications.

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 Envenomation by animal venoms:
• Skin sensitivity test should be done before administration of the antivenom. If the test is
positive and there is severe envenomation,

• Antivenom is given with premedication to guard against hypersensitivity reactions

(hydrocortisone and adrenaline).

• The dose of antivenom administered to neutralize the venom is the same for children and
adults as the amount of venom needed to be neutralized is the same in both.

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 Snake envenomation

• Snakes are reptiles with a worldwide distribution.

• Only about 15% of the 3000 species of snakes are venomous.

• They have poor vision and hearing, but they have a powerful smell sensation, and their
bodies are very sensitive to vibrations.

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 Snake envenomation
• Venom is injected in the victim through 2 fangs situated on both sides of the upper jaw.

• These fangs are connected to a pair of glands by narrow ducts.

• Dry bite: it occurs when venom is not injected during the bite by venomous snakes.

• It represents about 50% of bites and results in envenomation.

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 Venom composition and effects:

• The major groups of venom toxins are:

• Coagulations: these include phospholipase A2, metalloproteinases, fibrinolytics and

platelets factors. They attack hemostasis and vascular integrity resulting in coagulopathy,
hemorrhage and shock.

• Neurotoxins: these are peptides and phospholipase A2, they lead to flaccid paralysis of
skeletal muscles (causing respiratory failure).

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 Venom composition and effects:
• Cardiotoxins and nephrotoxins and they are mainly peptides.

• Myotoxins: these are mainly phospholipase A2. They cause myolysis of skeletal muscles.

• Neurotoxins: These are mainly proteolytic enzymes. They cause local tissue injury varying
from mild effect to major necrosis.

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 Viper envenomation:
• Local effects (they are so severe, and the condition may extend to gangrene):

• Fang marks: one or two.

• Local pain and bleeding from the fang marks.

• Edema which appear within few minutes and may progress to involve the whole limb.

• Enlarged tender regional lymph nodes.

• Ecchymosis: extravasation from damaged capillaries

• Blistering.

• Skin necrosis and dry gangrene.

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 Viper envenomation:
• General manifestations:

• Anxiety which may induce sweating, nausea, vomiting, rigors, tachycardia and chest tightness.

• Coagulopathy which occur mainly due to rapid fibrin formation then fibrinolysis leading to
consumption of fibrin, and to a lesser extent due to inhibition of portions of the clotting cascade
and the decrease in platelets count.

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 Viper envenomation:
• This leads to

• bleeding from all body orifices and presents as:

• Persistent bleeding from the bite site or venipuncture.

• Bleeding gums and epistaxis.

• Hematemesis and melena.

• Hematuria.

• DIC (dissiminated intravascular coagulopathy)

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 Viper envenomation
• Hemorrhage due to venom-induced capillary damage.

• Hemolysis due to the effect of the venom on red cell membranes. This presents as:

• Hemolytic anemia.

• Hemolytic jaundice.

• Cardiac and circulatory effects: usually secondary to hemorrhagic disturbances leading to

the occurrence of hypotension and shock.

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 Viper envenomation
Myotoxicity due to myolysis of skeletal muscles.

This presents as:

• Muscle pain, tenderness and weakness.

• Secondary renal failure due to myoglobinuria.

• Hyperkalemia which may result in cardiac arrhythmias.

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 Cobra envenomation:
Local effects:

• Fang marks: one or two.

• Minimal local pain and edema around the fang marks.

General manifestations:

• Anxiety which may induce sweating, nausea, vomiting, rigors, tachycardia and chest
tightness.

• Systemic symptoms usually occur within a few hours but may be delayed up to 12 hours.

• Fasciculation of face and neck muscles which is usually followed by paralysis.

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 Cobra envenomation:
• Weakness up to paralysis of skeletal muscles of the whole body including respiratory muscles
and muscles supplied by cranial nerves.

• This presents as:

• Diplopia, ptosis.
• Dysarthria.
• Generalized muscle weakness.
• Respiratory arrest

• Consciousness and sensation are spared.

• When the whole body is paralysed and cranial nerve palsy occurs, the patient looks as if
comatosed.

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 Diagnosis:

• History of a bite accompanied by seeing or capturing the snake.

• Examination: the presence of fang marks and the clinical manifestations.

• Investigations: in cases of viper envenomation the laboratory findings are anemia,

thrombocytopenia, hypofibrinogenemia, increased fibrin degradation products and
prolongation of PT and PTT (lab tests also help to follow up treatment).

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 Treatment:

• First aid treatment (pre-hospital care):

• Rest, reassurance and immobilization of the affected limb and removal of any
constricting object like rings or bracelets.

• A light tourniquet could be used but it is proved to be of limited value.

• Other measures like incision and suction, cryotherapy or electric shock are proved to
be harmful and they are now obsolete.

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 Hospital treatment:
• Emergency treatment ABCD:

• in cases of respiratory paralysis where mechanical ventilation is needed.

• Polyvalent antivenom: Antivenom is indicated in all systemic envenomation.

• Antigen-antibody reaction is the basic mechanism of snake venom neutralization

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 • It is best given within the first 2 hours to prevent local injury but it's never too late to give
the antivenom.

• It is given by slow intravenous injection or intravenous infusion.

• Administration of antivenom is dependent on the severity and the follow up of the patient.

• More could be given according to the evolution of the clinical condition and response to
antivenom.

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 Treatment of complications:

• Hypotension is treated by I.V fluids.

• Hemostatic abnormalities: are treated by fresh whole blood, fresh frozen plasma, platelets
concentrates and fibrinogen infusion.

• Tetanus prophylaxis is given to non-immune persons.

• Treatment of local complication in the form of debridement of necrotic tissue at the bite
site.

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