ANIMAL POISONS

By -
97. Y Pragna Sri.
100. A Praneetha.
OVERVIEW:-
1. Animal Poisons.
2. Snake Bite.
3. Scorpion Sting.
4. Bee Sting.
5. Wasp Sting.
6. References.
❖ Animal irritants include :
➢ Snake (venomous).
➢ Scorpion.
➢ Bee.
➢ Spider.
➢ Wasp.
➢ Etc.
 1. SNAKE BITE:-
VENOMOUS SNAKES NON VENOMOUS SNAKES

Poisonous. Not poisonous.

Stout, dull coloured. Slender, bright coloured.

Broad and complete belly Small, incomplete belly scales

Rounded/Flattened tail. Gradually tapering tail.

Fangs (modified teeth) Fangs absent.

E.g. Cobra, King Cobra, E.g. Rat snake, Vine snake,

❖ Types of Venom:
➢ Neurotoxic - Cobra, Krait.
➢ Hemotoxic - Vipers.
➢ Myotoxic - Sea snake.
❖ Clinical Features:
➢ Non-Poisonous :-
■ Fear, Apprehension.
■ Palpitations.
■ Sweating.
■ State of shock with feeble pulse, hypotention, syncope, rapid shallow
breathing and dilated pupils
❖ Clinical Features:
➢ Poisonous :-
■ Elapid Bite :
Local Features : Systemic Features :
● Fang marks. ● Pre-Paralytic stage - vomiting, headache,
● Burning pain. giddiness, weakness, lethargy.
● Swelling and discoloration (sometimes ● Paralytic stage - spreading paralytic features -
ptosis, opthalmoplegia, drowsiness,
blisters).
dysartheria, convulsions, bulbar paralysis,
● Serosanguinous discharge.
respiratory failure & death.

■ Viperid Bite :
Local Features : Systemic Features :
● Rapid swelling of the bitted site. ● Generalised bleeding - epistaxis, hemoptysis,
● Discoloration. hemetemesis, bleeding gums, hematuria,
● Blister formation. malena, hemorrhagic areas over skin and
● Bleeding from bite site. mucosa.
● Pain. ● Shock.
● Renal failure.

Systemic Features :
■ Sea Snake Bite : ● Myalgia.
Local Features : ● Muscle stiffness.
● Local swelling. ● Myoglobinuria.
● Pain. ● Renal failure.
❖ Diagnosis:
➢ Identification of Fang marks -
■ Two fang marks in the form of puncture wound (usually seperated by a
distance of 8mm to 4cm)
■ Single fang mark due to sideswipe.
■ Multiple fang marks when the area is bitten multiple times.
➢ Identification of snake - Vide supra.
➢ Laboratory Methods -
■ CBC - leucocytosis with thrombocytopenia.
■ Smear - hemolysed and fragmented RBCs.
■ Coagulation tests - Increased prothrombin time and partial
thromboplastin time.
■ Immunodiagnosis -
1. Immunodiffusion.
2. Counter-current immunoelectrophoresis.
3. ELISA.
4. Radio-immunoassay
❖ Management:
➢ Non-Poisonous Snake Bite :-
i. Allay anxiety and fear.
ii. Reassure the patient.
➢ Poisonous Snake Bite :-
i. First Aid & Field Management -
● Reassure the patient.
● Immobilize the affected part (to limit systemic spread)
● Viperid Bites - bitten limb should be splinted and kept
at approximately heart level.
● Elapid/Sea Snake Bites - Australian Pressure
Immobilization Technique (entire bitten limb wrapped
in elastic or crepe bandage and splinted)
● Tourniquet - proximal lymphatic occlusion constriction
band/tourniquet applied within 30 minutes.
ii. Hospital Management -
● Monitor Vitals, cardiac rhythm, oxygen saturation & urine output.
● Level of local swelling is marked and circumference measured
every 15 minutes until stabilized.
● Intravenous fluid resuscitation (vasopressors administered if
needed)
● Blood and urine collected for laboratory evaluation.
● Dry sterile dressings applied on bite site.
● Tetanus immunization as appropriate.
● Intracompartmental pressure is checked if swelling in the
affected limb continuesand impending tissue perfusion causing
muscle compartment syndrome.
● Promt surgical consultation obtained and antivenin therapy
continued if pressured is elevated.
● Antivenin Therapy:- (Monovalent or Polyvalent)
a. Indications -
■ Deranged coagulation profile.
■ Spontaneous bleeding.
■ Rapidly progressive, severe local swelling.
■ Persistent hypotension.
■ Neurotoxic or myotoxic features.
■ Depressed conciousness.
■ Laboratory abnormalities.
b. Administered with caution.
c. Administered as intravenous infusion.
d. Adverse Reactions -
■ Anaphylaxis.
■ Delayed hypersensitivity reaction.
● Severe hemorrhage or bleeding - blood/fresh frozen plasma required.
 ● Neurotoxicity - neostigmine (each dose preceded with atropine).
● Oxygen, ventilatory support.
● Management of renal failure

❖ Autopsy Findings:
➢ Evidence of fang marks, local swelling, discoloration, blister
formation, bleeding.
➢ Bleeding diathesis.
➢ Froth at mouth and nostrils.
➢ Pulmonary edema.
➢ Congested organs.
❖ Medicolegal Importance:
➢ Mostly accidental deaths.
➢ Permanent functional loss may occur in bitten limb.
2. SCORPION BITE :-

Venom contains :
● Phospholipase.
● Acetyle cholinesterase.
● Hyaluronidase.
● Serotonin.
● Neurotoxin.
❖ Clinical Features:
➢ Local Features:-
■ Increasing local pain (burning and excruciating)
■ Swelling.
■ Redness.
■ Itching.
■ Ecchymosis.
➢ Systemic Features:-
■ Sweating. ● Brady-arrhythmias.
■ Utricaria. ● Pulmonary edema.
■ Salvation. ● Myocarditis.
● Myocardial ischemia.
■ Vomiting.
● Restlessness.
■ Breathlessness, cough.
● Giddiness.
■ Hemoptysis. ● Convulsions.
■ Priapism. ● Intracerebral haemorrhage leading
■ Hypertension. to paralysis.
❖ Laboratory Findings:
➢ ECG - ST segment depression or elevation, acute myocardial
infarction like pattern, inverted T waves, left anterior hemiblock, Q
waves.
➢ Elevated Creatine Phospokinase.
❖ Management:
➢ Immobilised affected limb.
➢ Oxygen administration.
➢ Prazosin (post-synaptic α-blocker - reverses inotropic and
hypokinetic phases, and metabolic effects caused by depressed
insulin secretion.
➢ For pts with hypotension and marked tachycardia, Inotropic support
(e.g. Dobutamine) given.
➢ Sodium nitroprusside for massive pulmonary edema.
➢ Antivenom therapy for potentially life threatening complications.
❖ Autopsy Findings:
➢ Local part - swollen, inflamed, sting may be present, with
hemorrhagic infiltration in surrounding tissue.
➢ Sting sites - usually at peripheral sites (toes, palms, singers,
soles, etc.)
➢ Systemic examination -
■ pulmonary edema.
■ Pulmonary hemorrhages.
■ GIT hemorrhages.
■ Intracerebral hemorrhage.
■ Signs of consumption coagulopathy.
■ Myocarditis.
❖ Medicolegal Importance:
➢ Accidental envenomation.
➢ More fatal in children.
 3. BEE STING:-
Bee venom contains :
➢ Biogenic amines -
■ Histamine.
■ 5-hydroxy typtamine.
■ Acetylcholine.
■ Apamin.
➢ Enzymes -
■ Phospholipase A.
■ Hyaluronidase.
■ Acid Phosphatase.
■ Minimine.
➢ Toxic peptides -
■ Mellitin.
■ Apamin.
■ Mast cell degranulating peptide.
❖ Clinical Features:
➢ Local Features :
■ Pain
■ Redness
■ Swelling
■ Pruritis
■ If stinging occurs in mouth or in tongue may lead to airway
obstruction by developing edema and dysphagia.Uvulitis may occur.
➢ Systemic Features :
■ Person allergic to bee venom may develop anaphylaxis
■ Tingling sensation
■ Flushing
■ Dizziness
■ Visual disturbance
■ Syncope
● Syncope
● Vomiting
● Wheezing
● Urticaria
● Angiedema
● Glotic edema
● Coma
● Renal failure
● Rhabdomyolysis
❖ Management:-
➢ The stings of honeybees should be removed quickly.Removal of
bee sting that have been embedded for more than one minute will
have little or no effect in reducing envenomation since most of the
venom empties from detached honeybee stings within 10 to 20 sec
➢ Patient with systemic reaction (shock,branchospasm,generalized
urticaria or angioedema) should be treated with parental
epinephrine.
➢ Patient should be observed for delayed, manifestations.
➢ Serum levels of hemoglobin and myoglobin should be observed.
➢ Renal failures should be treated on conventional line with
intravenous fluid and diuretics. Dialysis may be required.
➢ Antihistamines
4. WASP STING :-
❖ Wasp venom is composed of following:
➢ Biogenic amines :-
■ Histamine
■ 5-hydroxy typtamine
■ Acetylcholine
➢ Enzymes :-
■ Phospholipase A and B
■ Hyaluronidase
➢ Toxic peptides :-
■ Kinin
➢ Others :-
■ Antigen-5,acid Phosphatase
❖ Clinical Features :-
➢ Local Features :-
■ Pain
■ Redness
■ Swelling
➢ Systemic Features :-
■ Person allergic to venom may develop anaphylaxis
■ Tingling sensation
■ Flushing
■ Dizziness
■ Syncope
■ Vomiting
■ Wheezing
■ Urticaria
■ Angioedema
■ Renal failure
❖ Management:-
➢ Patient with systemic reaction (shock, branchospasm,
generalized urticaria or angioedema) should be treated with
parental epinephrine.
➢ Patient should be observed for delayed manifestations.
➢ Serum levels of hemoglobin and myoglobin should be observed.
➢ Antihistamines
➢ Analgesics for pain.
REFERENCES :-
1. Rajesh Bhardale Principles of Forensic Medicine and Toxicology.
2. Internet.
THANK YOU