title: Clinical effects of red-bellied black snake (Pseudechis porphyriacus) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP-11).
abstract: OBJECTIVE
  To describe the clinical features and laboratory findings in patients with definite red-bellied black snake (RBBS; Pseudechis porphyriacus) bites, including correlation with results of venom assays.
  
  
  METHODS
  Prospective cohort study of patients with definite RBBS bites, recruited to the Australian Snakebite Project from January 2002 to June 2010.
  
  
  METHODS
  Clinical and laboratory features of envenoming; peak venom concentrations and antivenom treatment.
  
  
  RESULTS
  There were 81 definite RBBS bites; systemic envenoming occurred in 57 patients (70%) and local envenoming alone occurred in one patient. Systemic envenoming was characterised by local envenoming in 55 patients (96%), systemic symptoms in 54 patients (95%), anticoagulant coagulopathy with a raised activated partial thromboplastin time (aPTT) in 35 patients (61%) and myotoxicity in seven patients (12%). One patient required non-invasive ventilation for severe myotoxicity that resulted in muscle weakness. Three patients developed local ulceration. There were no deaths. Twenty-two envenomed patients (39%) received tiger snake or black snake antivenom, and administration within 6 hours of the bite was associated with normalisation of the aPTT. Eight patients (36%) had immediate hypersensitivity reactions to antivenom, including one case of anaphylaxis. The median peak venom concentration in 37 systemically envenomed patients with serum available was 19 ng/mL (interquartile range, 12-50 ng/mL; range, 3-360 ng/mL), which did not correlate with clinical severity. In 17 patients who received antivenom and had venom concentration measured, no venom was detected in serum after the first antivenom dose, including nine who were given one vial of tiger snake antivenom.
  
  
  CONCLUSIONS
  RBBS envenoming caused local effects, systemic symptoms, anticoagulant coagulopathy and, uncommonly, myotoxicity. One vial of tiger snake or black snake antivenom appears to be sufficient to remove venom and neutralise reversible effects, but hypersensitivity reactions occurred in over a third of patients.
authors.affiliation: Emergency Department, Princess Alexandra Hospital, Brisbane, QLD, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Churchman
authors.forename: Margaret A
authors.initials: MA
authors.lastname: O'Leary
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Buckley
authors.forename: Colin B
authors.initials: CB
authors.lastname: Page
authors.forename: Alan
authors.initials: A
authors.lastname: Tankel
authors.forename: Chris
authors.initials: C
authors.lastname: Gavaghan
authors.forename: Anna
authors.initials: A
authors.lastname: Holdgate
authors.forename: Simon G A
authors.initials: SG
authors.lastname: Brown
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Isbister
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000997:Antivenins; D001315:Australia; D002648:Child; D002675:Child, Preschool; D003402:Creatine Kinase / Q000097:blood; D004546:Elapid Venoms / Q000032:analysis; D017815:Elapidae; D005260:Female; D006801:Humans; D009498:Neurotoxins / Q000032:analysis; D010314:Partial Thromboplastin Time; D012909:Snake Bites / Q000097:blood / Q000453:epidemiology*; D013577:Syndrome; D055815:Young Adult
chemical_list: D000997:Antivenins; D004546:Elapid Venoms; D009498:Neurotoxins; C026235:Pseudechis venom; D003402:Creatine Kinase