Envenoming is rare in Australia — multicentre studies are needed to improve the tenuous evidence base
Whether it’s the live snake that escapes in an emergency department or the farmer, bitten by a brown snake, who drops into his wife’s work to say he will be in hospital, and then collapses and has a seizure on arriving in hospital — bites and stings are a fascinating topic and the occasional envenoming presenting to hospital makes the local news. Unfortunately, the rarity of envenoming in Australia has meant the evidence base in clinical toxinology is tenuous, with considerable reliance on case reports and anecdotes of successful treatment. Although case reports can be essential in providing information about rare effects, more importantly they help to develop hypotheses for further studies.
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- Newcastle Mater Misericordiae Hospital, Waratah, NSW.
- 1. Isbister GK, Graudins A, White J, Warrell D. Antivenom treatment in arachnidism. J Toxicol Clin Toxicol 2003; 41: 291-300.
- 2. Hartman LJ, Sutherland SK. Funnel-web spider (Atrax robustus) antivenom in the treatment of human envenomation. Med J Aust 1984; 141: 796-799.
- 3. Fisher MM, Bowey CJ. Urban envenomation. Med J Aust 1989; 150: 695-698.
- 4. Currie BJ. Marine antivenoms. J Toxicol Clin Toxicol 2003; 41: 301-308.
- 5. Ramasamy S, Isbister GK, Seymour JE, Hodgson WC. The in vivo cardiovascular effects of box jellyfish Chironex fleckeri venom in rats: efficacy of pre-treatment with antivenom, verapamil and magnesium sulphate. Toxicon 2004; 43: 685-690.
- 6. Huynh TT, Seymour J, Pereira P, et al. Severity of Irukandji syndrome and nematocyst identification from skin scrapings. Med J Aust 2003; 178: 38-41. <MJA full text>
- 7. Macrokanis CJ, Hall NL, Mein JK. Irukandji syndrome in northern Western Australia: an emerging health problem. Med J Aust 2004; 181: 699-702. <MJA full text>
- 8. Fenner PJ, Lewin M. Sublingual glyceryl trinitrate as prehospital treatment for hypertension in Irukandji syndrome. Med J Aust 2003; 179: 655. <MJA full text>
- 9. Little M. Is there a role for the use of pressure immobilisation bandages in the treatment of jellyfish envenomation in Australia? Emerg Med (Fremantle) 2002; 14: 171-174.
- 10. Burnett JW, Calton GJ. The case for verapamil in alarming jellyfish stings remains. Toxicon 2004; 44: 817-818.
- 11. Seymour J, Carrette T, Cullen P, et al. The use of pressure immobilization bandages in the first aid management of cubozoan envenomings. Toxicon 2002; 40: 1503.
- 12. Tibballs J, Williams D, Sutherland SK. The effects of antivenom and verapamil on the haemodynamic actions of Chironex fleckeri (box jellyfish) venom. Anaesth Intensive Care 1998; 26: 40-45.
- 13. Yeung JM, Little M, Murray LM, et al. Antivenom dosing in 35 patients with severe brown snake (Pseudonaja) envenoming in Western Australia over 10 years. Med J Aust 2004; 181: 703-705. <MJA full text>
- 14. Riviere G, Choumet V, Audebert F, et al. Effect of antivenom on venom pharmacokinetics in experimentally envenomed rabbits: toward an optimization of antivenom therapy. J Pharmacol Exp Ther 1997; 281: 1-8.
- 15. Currie BJ. Snakebite in tropical Australia: a prospective study in the “Top End” of the Northern Territory. Med J Aust 2004; 181: 693-697. <MJA full text>
- 16. Nuchpraryoon I, Garner P. Interventions for preventing reactions to snake antivenom. Cochrane Database Syst Rev 2000; (2): CD002153.
- 17. Gawarammana IB, Kularatne SAM, Dissanayake WP, et al. Parallel infusion of hydrocortisone ± chlorpheniramine bolus injection to prevent acute adverse reactions to antivenom for snakebites. A randomised, double-blind, placebo-controlled study. Med J Aust 2004; 180: 20-23. <MJA full text>
- 18. Brown SG. Parallel infusion of hydrocortisone with/without chlorpheniramine bolus injection to prevent acute adverse reactions to antivenom for snakebites. Med J Aust 2004; 180: 428-429. <MJA full text>