title: The Australian mulga snake (Pseudechis australis: Elapidae): report of a large case series of bites and review of current knowledge.
abstract: BACKGROUND
  The mulga snake (Pseudechis australis) is the largest terrestrial venomous snake in Australia. It is capable of inflicting severe and occasionally fatal envenoming, but there have been few studies of P. australis bites.
  
  
  OBJECTIVE
  To highlight and reinforce the main features of P. australis envenoming and to provide a clearer picture of the epidemiology of bites from this species.
  
  
  METHODS
  Selected case records kept by the Toxinology Dept. (Women's and Children's Hospital, Adelaide, Australia) were reviewed retrospectively to determine definite P. australis bites.
  
  
  METHODS
  definite cases where the snake was identified by a competent person and/or lab specimens (bite site/urine) tested positive for "black snake" using CSL snake venom detection kit in a locality within the known range of P. australis, but without sympatry with other Pseudechis spp.
  
  
  METHODS
  where the snake could not be clearly identified under criteria above. Epidemiological and clinical information was recorded and analysed for the definite cases.
  
  
  RESULTS
  A total of 27 cases were identified as definite P. australis bites; there were no fatalities. The median age was 35.5 years (IQR 51-23) and 80% of bites occurred in males. More bites occurred in the warmer months (Dec-March) and in those handling/interfering with snakes. Seven people were bitten whilst asleep at night. 21/27 patients developed systemic envenoming (based on signs, symptoms and laboratory results) and 17 cases received antivenom. Local bite site pain (18) and swelling (17) were common as were non-specific generalised symptoms such as nausea, vomiting and headache. Myotoxicity (11) and anticoagulant coagulopathy (10) occurred frequently; haemolysis was seen in fewer cases (3). Two patients developed local tissue injury around the bite site requiring further treatment.
  
  
  CONCLUSIONS
  This study confirms previous reports about P. australis bites with respect to high rates of envenoming, commonly associated with pain and swelling and systemic effects of rhabdomyolysis and anticoagulant coagulopathy. Systemic envenoming, even severe cases, responds well to antivenom therapy. Compared to other Australian snakes, a high proportion of bites occur in people asleep at night. Medically significant local tissue injury around the bite site may occur and may be associated with inappropriate first-aid, particularly the vascular occlusive type.
authors.affiliation: Toxinology Department, Women's & Children's Hospital, North Adelaide, SA 5006, Australia; Medical School, University of Bristol, Bristol BS8 1TH, UK.
authors.forename: Shahab
authors.initials: S
authors.lastname: Razavi
authors.affiliation: Toxinology Department, Women's & Children's Hospital, North Adelaide, SA 5006, Australia.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Weinstein
authors.affiliation: Toxinology Department, Women's & Children's Hospital, North Adelaide, SA 5006, Australia. Electronic address: david.bates@adelaide.edu.au.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bates
authors.affiliation: Emergency Department, Royal Adelaide Hospital, North Tce, Adelaide, SA 5000, Australia.
authors.forename: Sam
authors.initials: S
authors.lastname: Alfred
authors.affiliation: Toxinology Department, Women's & Children's Hospital, North Adelaide, SA 5006, Australia.
authors.forename: Julian
authors.initials: J
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D001315:Australia; D002648:Child; D003131:Combined Modality Therapy; D004546:Elapid Venoms / Q000037:antagonists & inhibitors / Q000633:toxicity*; D017815:Elapidae; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009498:Neurotoxins / Q000037:antagonists & inhibitors / Q000633:toxicity*; D012621:Seasons; D012909:Snake Bites / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000997:Antivenins; D004546:Elapid Venoms; D009498:Neurotoxins; C026235:Pseudechis venom
keywords: Clinical case; Envenoming; Local effects; Mulga snake; Myotoxicity; Pseudechis australis