title: Efficacy of Trypsin in Treating Coral Snake Envenomation in the Porcine Model.
abstract: Antivenom is the definitive treatment for venomous snakebites. Alternative treatments warrant investigation because antivenom is sometimes unavailable, expensive, and can have deleterious side effects. This study assesses the efficacy of trypsin to treat coral snake envenomation in an in vivo porcine model. A randomized, blinded study was conducted. Subjects were 13 pigs injected subcutaneously with 1 mL of eastern coral snake venom (10 mg/mL) in the right distal hind limb. After 1 min, subjects were randomized to have the envenomation site injected with either 1 mL of saline or 1 mL of trypsin (100 mg/mL) by a blinded investigator. Clinical endpoint was survival for 72 h or respiratory depression defined as respiratory rate <15 breaths per minute, falling pulse oximetry, or agonal respirations. Fisher's exact t test was used for between group comparisons. Average time to toxicity for the saline control was 263 min (191-305 min). The development of respiratory depression occurred more frequently in control pigs than treated pigs (p = 0.009). Four of the six pigs that received trypsin survived to the end of the 3-day study. No control pigs survived. Two of the trypsin treatment pigs died with times to toxicity of 718 and 971 min. Survival to 12 and 24 h was significantly greater in the trypsin treatment group (p = 0.002, p = 0.009, respectively). Local injection of trypsin, a proteolytic enzyme, at the site of envenomation decreased the toxicity of eastern coral snake venom and increased survival significantly. Further investigation is required before these results can be extended to human snakebites.
authors.affiliation: Department of Emergency Medicine, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Room 3ED311, Greenville, NC, 27834, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Parker-Cote
authors.affiliation: Department of Comparative Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
authors.forename: Dorcas P
authors.initials: DP
authors.lastname: O'Rourke
authors.affiliation: Department of Emergency Medicine, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Room 3ED311, Greenville, NC, 27834, USA.
authors.forename: Kori L
authors.initials: KL
authors.lastname: Brewer
authors.affiliation: Department of Comparative Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
authors.forename: Kvin
authors.initials: K
authors.lastname: Lertpiriyapong
authors.affiliation: Department of Emergency Medicine, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Room 3ED311, Greenville, NC, 27834, USA.
authors.forename: Mohan
authors.initials: M
authors.lastname: Punja
authors.affiliation: Department of Emergency Medicine, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Room 3ED311, Greenville, NC, 27834, USA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Bush
authors.affiliation: Department of Emergency Medicine, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Room 3ED311, Greenville, NC, 27834, USA.
authors.forename: Susan N
authors.initials: SN
authors.lastname: Miller
authors.affiliation: Department of Emergency Medicine, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Room 3ED311, Greenville, NC, 27834, USA. meggsw@ecu.edu.
authors.forename: William J
authors.initials: WJ
authors.lastname: Meggs
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004546:Elapid Venoms / Q000506:poisoning*; D017815:Elapidae; D005260:Female; D011897:Random Allocation; D012909:Snake Bites / Q000188:drug therapy*; D013552:Swine; D014357:Trypsin / Q000627:therapeutic use*
chemical_list: D004546:Elapid Venoms; D014357:Trypsin
keywords: Coral snake; Envenomation; Snakebite; Trypsin