A case of snakebite with unusual features

LumBt.EY, J ., WIT T JAMNON, J . A ., FENNER, P. J ., BuRrnrrr, J . W . and CoLQuxouN, D . M . Fatal envenomation by Chironex fleckeri, the north Australian boxjellyfish : the continuing search for lethal mechanisms. Med. J. Aust . 148, 527 (1988). Tins IMPORTANT paper not only reports a fatal box-jellyfish sting to a 5 year old boy, but discusses new insights into envenomation by Chironex fkckeri, and revised guidelines for treatment, which all toxinologists likely to treat cases should become familiar with. The child died of cardiac arrest within 20 min of the sting, possibly due directly to venom induced injury. Early and vigorous rescussitation is encouraged, and in managing unresponsive cardiac arrest i .v . verapamil is recommended, plus additional CSL boxjellyfish antivenom . J . WHITE

CuRRn?~ B., FrmmAuRim, M . and OAKLEY, J. Resolution of neurotoxicity with anticholinesterase therapy in death-adder envenomation. Med. J. Aust . 148, 522 (1988) . A cAw report of a Papua New Guinea native, age 40 years, who developed partial neurotoxic paralysis following a death adder, Acanthophis antarcticus, bite. Neostigmine methylsulphate 2.5 mg i .v. apparently reversed his neurotoxic symptoms within a matter of minutes, although CSL death adder antivenom was also subsequently administered as a precaution . A useful discussion is included, pointing out the likely ineffectiveness of anticholinesterase in taipan (Oxyuranus) bites with paralysis, as well as the potential value of acetylcholinesterases in the therapy of snakebite in parts of Papua New Guinea . J . WHITE

FE~ P. J., WLL~N, J. A ., BuitNSrr, J . W ., CoLQuHouN, D . M., GODFREY, S ., GUNAWARDANE, K . and MURTHA, W. The "Irukandji Syndrome" and acute pulmonary oedema. Med. J. Aust . 149,150 (1988). AN IMPORTANT review of envenomation by the Irukankji (jellyfish), Carukia barnesi, including reports of three probable cases, with pulmonary oedema, which the authors suggest may be due to direct myocardial depression and pulmonary capillary leakage. Vinegar apparently inhibits nematocyst discharge. Suggested treatment plan for severe cases of "Irukandji Syndrome" involves pain relief, management of apparent endogenous catecholamine excess, and aggressive treatment of pulmonary oedema and hypoxia, including oxygen, Swan-Ganz catheterization, and consideration of early intubation with IPPV. J. WHITE

POTIER,

D . and GAUDRY, P . A case of snakebite with unusual features . Med. J. Aust. 149, 565 (1988) .

LsrmR to the Editor reporting a red-bellied black snake (Pseudechis porphyriacus) bite to the hand of a 24 year old man, who developed evidence of possible mild myolysis (peak CK 1460 p/1 on day 4), and apparent compartmental syndrome of the left forearm flexor compartment. The latter may have been secondary to inappropriate use of an arterial tourniquet as first aid. J . WHITE

MORRIS, B ., SouTxcoTr, R . V. and GAiA A. E . Effects of stings of Australian native bees . Med. J. Aust . 149, 707 (1988) . FwE cAm of stings by native bees are reported . The reactions were various and include a fatality as a result of the sting of a presumed Lagioglossum sp . (Halictidae) . The effects of stings from Lggioglossum app., Homalictus dotatus (Cockerell) (Halictidae), and Euryglossa cf. adelaidae Cockerell (Colletidae) are described. The rarity of severe allergic reactions to native bees and the rarity of stings by the same species makes a programme of immunotherapy inappropriate . (Authors abstract .) J . WHITE