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Thirty-two patients with enzyme-immunoassay-proven death adder (Acanthophis sp.) bites were studied in Port Moresby, Papua New Guinea. Eighteen were envenomed; local signs were rare and none had incoagulable blood, but all except one had signs of neurotoxicity. Five (27.7%) envenomed patients required intubation and ventilation. One patient developed renal failure, previously undescribed following death adder bites. Laboratory investigations showed mild prolongation of prothrombin and partial thromboplastin times in some patients. In vitro studies showed that the venom contains anticoagulant activity, but does not cause fibrinogenolysis. In contrast to taipan envenoming, neurotoxicity did not progress after antivenom administration, and there was reversal of neurotoxicity, evident within 6 h, in three severely envenomed patients treated less than 12 h after the bite. One patient treated with antivenom and anticholinesterases had the most dramatic response to treatment; the optimum management of bites by this species may include prompt treatment with both antivenom and anticholinesterases in addition to effective first aid.

Type

Journal article

Journal

QJM

Publication Date

01/1996

Volume

89

Pages

25 - 35

Keywords

Adolescent, Adult, Aged, Animals, Antivenins, Blood Coagulation, Child, Cholinesterase Inhibitors, Female, Humans, Male, Middle Aged, Nervous System, Papua New Guinea, Rhabdomyolysis, Snake Bites, Viper Venoms, Viperidae