title: Neurotoxicity, anticoagulant activity and evidence of rhabdomyolysis in patients bitten by death adders (Acanthophis sp.) in southern Papua New Guinea.
abstract: 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.
authors.affiliation: Department of Clinical Sciences, University of Papua New Guinea, Port Moresby.
authors.forename: D G
authors.initials: DG
authors.lastname: Lalloo
authors.forename: A J
authors.initials: AJ
authors.lastname: Trevett
authors.forename: J
authors.initials: J
authors.lastname: Black
authors.forename: J
authors.initials: J
authors.lastname: Mapao
authors.forename: A
authors.initials: A
authors.lastname: Saweri
authors.forename: S
authors.initials: S
authors.lastname: Naraqi
authors.forename: D
authors.initials: D
authors.lastname: Owens
authors.forename: A S
authors.initials: AS
authors.lastname: Kamiguti
authors.forename: R A
authors.initials: RA
authors.lastname: Hutton
authors.forename: R D
authors.initials: RD
authors.lastname: Theakston
authors.forename: D A
authors.initials: DA
authors.lastname: Warrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects*; D002648:Child; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000187:drug effects; D010219:Papua New Guinea; D012206:Rhabdomyolysis / Q000209:etiology*; D012909:Snake Bites / Q000097:blood* / Q000150:complications* / Q000628:therapy; D014757:Viper Venoms / Q000506:poisoning*; D017819:Viperidae
chemical_list: D000997:Antivenins; D002800:Cholinesterase Inhibitors; D014757:Viper Venoms