Snake toxicology

epidemiology

• all continents have venomous snakes
• America 4,000 deaths
• Africa >>20,000 (too under-reported)
• Asia >75,000
  • India 58,000
  • Japan ≈10 deaths amongst 2-3,000 bites
• Europa <50
• Papua New Guinea >300
• many survivors suffered from serious disability > 60,000 DALYs

species

• Viperidae
• Elapidae
• Lamprophiidae
• "Colubridae"

venom

• enzymes, proteins, polypeptides
• 90% dry weight
• >100 different agents in each venom
• ≈50% of all snake bites by venomous snakes inject no venom - "dry bites"
  • traditional but dangerous and not effective therapies mimic effective
• neurotoxic
• coagulation inhibition

first aid

1. reassure
2. immobilise whole body, esp. bitten limb
3. remove tight rings etc.
4. apply pressure pad/bandage on bitten sites
5. consider to give anticholinestarase

never do

• vacuum extractor
• too tight bandage
• incisions

physical exam

• exclude shock/hypovolemia
  • postural hypotension
• exclude neurotoxicity
  • bilateral ptosis, let patient look upward
• exclude coagulopathy/bleeding
  • 20 min whole blood clotting test - always use glass container