- Email: [email protected]
Northern Pacific rattlesnake (Crotalus oreganus) envenomation leads to ocular destruction and coagulopathy
Abstracts / Toxicon 119 (2016) 371e376
lasting effects. By analyzing detailed bite reports, it is possible to make cautious extrapolations on the trends of the venom on the human body. This information can be used in future treatments of Carolina Pigmy Rattlesnake envenomations. Keywords: Envenomation, Sisturus, cytotoxin A RARE CHINESE PIT VIPER IN MINNESOTA: PROTOBOTHROPS MANGSHANENSIS ENVENOMATION Daniel E. Keyler 1, 2, Jon B. Cole 3, Travis Olives 3, 4, Terry Phillip 5. 1
Ainimal Venom Research International, Moreno Valley, CA, USA; Dept. of Experimental & Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA; 3 Minnesota Poison Control System, Minneapolis, MN, USA; 4 HealthPartners Toxicology Education & Clinical Service, St. Paul, MN, USA; 5 Reptile Gardens, Rapid City, SD, USA 2
E-mail address: [email protected].
Background: The Mount Mang or Mangshan Laotietou also known as the Chinese or Mangshan pit viper (Protobothrops mangshanensis) has gone through several genera changes, is a CITES 2 species, and a rare snake of beautiful color morphology. Existing in a highly restricted mountain range of less than 100 square kilometers in the Hunan Province of China, a few specimens arrived in zoos following its discovery in 1989. Given the rarity of the species demand arose, and via questionable sources seeking economic benefit, the snake has begun to appear in a limited number of amateur collections. A single envenomation case has been reported previously (Czech Republic) in which delayed and prolonged coagulopathy occurred, and Green Pit Viper Antivenin (Thai Red Cross) appeared to have provided paraspecific coverage. Here a case of Mangshan pit viper envenomation (a species for which no specific antivenom is available) occurred in Minnesota, and a cascade of events demonstrate the complexities of treating victims of envenomation from non-native species. Methods: Case report. A 33 yo M was bitten by and adult female P. mangshanensis while trying to remove eggs that she appeared to be incubating. The patient was admitted to the hospital. Despite local bite wound symptoms, only a mild coagulopathy was observed, and the patient was discharged at 3 days with intended follow-up laboratory monitoring. During this time the patient’s snakes had been confiscated by Animal Control, and the patient was distraught. Following the 3rd day post envenomation the patient returned to the ED as he was not feeling “normal”. His previous venipuncture sites showed mild bleeding, and when tape was pulled away from the skin there appeared to be capillary blood leakage. Labs were drawn, but the patient signed out AMA prior to the results, which showed his INR/aPTT/TT were immeasurably long. Through the help of police and family the patient was located and convinced to return to the hospital. Green Pit Viper Antivenin (Thai Red Cross) had been flown in from Reptile Gardens and 3 vials were administered 5 days post envenomation. Results: Antivenom was administered without adverse effect. Patient coagulation parameters returned toward normal, and the patient was discharged after 7 days of intermittent medical care. Conclusion: Envenomation by P. mangshanensis initially resulted in a mildly symptomatic coagulopathic process, was followed by delayed increased coagulopathy, and late administration of a non-specific antivenom, Green Pit Viper Antivenin, appeared to provide paraspecifc effect. Keywords: Snakebite, Coagulopathy, Antivenom, Protobothrops mangshanensis NORTHERN PACIFIC RATTLESNAKE (CROTALUS OREGANUS) ENVENOMATION LEADS TO OCULAR DESTRUCTION AND COAGULOPATHY Michael Touger 1, 2, Denise Fernendez 3, Michael Lamberta 1, Lewis Nelson 3, 4. 1
Albert Einstein College of Medicine, Bronx, NY, USA; Jacobi Medical Center, Bronx, NY, USA; 3 New York City Poison Control Center, NY, USA; 2
4
375
Bellevue Hospital Center, NY, USA
E-mail address: [email protected].
Case Report: A 23 year old man with no past medical history presented to a suburban New York City hospital during April 2015 ten hours after sustaining a bite to his right eye from his pet Northern Pacific Rattlesnake (Crotalus oreganus, NPRS). On arrival he was somnolent. His vital signs were: BP 140/88 mmHg; HR 99/min: and oxygen saturation 100% on 2L NC. Physical exam revealed bilateral periorbital edema and ecchymosis greater on the right. The right globe appeared proptotic with chemosis and diffuse subconjunctival hemorrhage. Intraocular pressure was 18 mmHg and a positive Seidel test was noted. Initial laboratory testing revealed: lactate 3.1 mg/dL, potassium 5.6 mEq/L, platelets 13x103/mm3, PT 12.2 sec, INR 1.1. On repeat testing the potassium was 8 mEq/L, likely due to hemolysis. He was intubated for airway protection and treated for hyperkalemia. He was transferred to our regional snakebite center and received a total of 23 vials of ovine antivenom following current manufacturer recommendations. Repeat platelet count improved to 140x103mm3 and potassium to 5.3 mEq/L. Outpatient follow up revealed recurrent thrombocytopenia with a platelet count of 51x103mm3 daY 7 post envenomation. His platelet count normalized by day 13 without further intervention. Case Discussion: NPRS has a complex venom capable of causing significant local tissue damage and coagulopathy. This case is unique in that it demonstrates globe rupture after NPRS envenomation complicated by coagulopathy. The right eye underwent surgical repair but unfortunately vision in that eye was not preserved. Conclusion: To our knowledge this is the first report of globe rupture caused by NPRS envenomation. The coagulopathy responded to standard antivenom therapy but vision was lost in the injured eye. Keywords: Snakebite, Globe rupture
Venomous animal biology PARADOXICAL EXCEPTION TO ISLAND TAMENESS: INCREASED DEFENSIVENESS IN AN INSULAR POPULATION OF RATTLESNAKES Carl E. Person 1, Gerad A. Fox 1, Julie King 2, Eric C.K. Gren 1, Erick Briggs 3, William K. Hayes 1. 1 Department of Earth and Biological Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA; 2 Catalina Island Conservancy, Avalon, CA, USA; 3 Natural Solutions, Yucca Valley, CA, USA
E-mail address: [email protected].
Background: Island tameness exists among diverse animal taxa on islands worldwide, and results largely from a lack of natural predators. Several insular populations of rattlesnakes lack functional rattles, which has been interpreted as the consequence of relaxed selection arising from isolation and reduced predation. Accordingly, one might expect island populations of rattlesnakes to exhibit a decrement in defensive behavior relative to their mainland counterparts. Methods: We tested this hypothesis by comparing species-typical antipredator behaviors and venom expenditure during defensive bites by mainland (N ¼ 20) versus Santa Catalina Island, California, USA (N ¼ 10), populations of the dangerously venomous southern Pacific rattlesnake (Crotalus oreganus helleri). Results: Contrary to our prediction, rattlesnakes from the island not only lacked tameness compared to mainland snakes, but they also exhibited measurably greater levels of defensiveness. Island snakes attempted to bite 4.7 times more frequently as we endeavored to secure them by hand, and as a result they required 2.1-fold more time to be pinned and captured by hand compared to mainland snakes. When controlling for body size, the island snakes also delivered 2.1-fold greater quantities of venom when biting after being grasped. The additional venom resulted from 2.1-fold larger boluses of venom ejected from the fangs during a given bite. Relative head size was equal among snakes from the two populations, so differences in venom expenditure likely reflected behavioral decisions associated with risk assessment and level of defensiveness. No effect of duration in captivity (2e36 months) existed, which
lasting effects. By analyzing detailed bite reports, it is possible to make cautious extrapolations on the trends of the venom on the human body. This information can be used in future treatments of Carolina Pigmy Rattlesnake envenomations. Keywords: Envenomation, Sisturus, cytotoxin A RARE CHINESE PIT VIPER IN MINNESOTA: PROTOBOTHROPS MANGSHANENSIS ENVENOMATION Daniel E. Keyler 1, 2, Jon B. Cole 3, Travis Olives 3, 4, Terry Phillip 5. 1
Ainimal Venom Research International, Moreno Valley, CA, USA; Dept. of Experimental & Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA; 3 Minnesota Poison Control System, Minneapolis, MN, USA; 4 HealthPartners Toxicology Education & Clinical Service, St. Paul, MN, USA; 5 Reptile Gardens, Rapid City, SD, USA 2
E-mail address: [email protected].
Background: The Mount Mang or Mangshan Laotietou also known as the Chinese or Mangshan pit viper (Protobothrops mangshanensis) has gone through several genera changes, is a CITES 2 species, and a rare snake of beautiful color morphology. Existing in a highly restricted mountain range of less than 100 square kilometers in the Hunan Province of China, a few specimens arrived in zoos following its discovery in 1989. Given the rarity of the species demand arose, and via questionable sources seeking economic benefit, the snake has begun to appear in a limited number of amateur collections. A single envenomation case has been reported previously (Czech Republic) in which delayed and prolonged coagulopathy occurred, and Green Pit Viper Antivenin (Thai Red Cross) appeared to have provided paraspecific coverage. Here a case of Mangshan pit viper envenomation (a species for which no specific antivenom is available) occurred in Minnesota, and a cascade of events demonstrate the complexities of treating victims of envenomation from non-native species. Methods: Case report. A 33 yo M was bitten by and adult female P. mangshanensis while trying to remove eggs that she appeared to be incubating. The patient was admitted to the hospital. Despite local bite wound symptoms, only a mild coagulopathy was observed, and the patient was discharged at 3 days with intended follow-up laboratory monitoring. During this time the patient’s snakes had been confiscated by Animal Control, and the patient was distraught. Following the 3rd day post envenomation the patient returned to the ED as he was not feeling “normal”. His previous venipuncture sites showed mild bleeding, and when tape was pulled away from the skin there appeared to be capillary blood leakage. Labs were drawn, but the patient signed out AMA prior to the results, which showed his INR/aPTT/TT were immeasurably long. Through the help of police and family the patient was located and convinced to return to the hospital. Green Pit Viper Antivenin (Thai Red Cross) had been flown in from Reptile Gardens and 3 vials were administered 5 days post envenomation. Results: Antivenom was administered without adverse effect. Patient coagulation parameters returned toward normal, and the patient was discharged after 7 days of intermittent medical care. Conclusion: Envenomation by P. mangshanensis initially resulted in a mildly symptomatic coagulopathic process, was followed by delayed increased coagulopathy, and late administration of a non-specific antivenom, Green Pit Viper Antivenin, appeared to provide paraspecifc effect. Keywords: Snakebite, Coagulopathy, Antivenom, Protobothrops mangshanensis NORTHERN PACIFIC RATTLESNAKE (CROTALUS OREGANUS) ENVENOMATION LEADS TO OCULAR DESTRUCTION AND COAGULOPATHY Michael Touger 1, 2, Denise Fernendez 3, Michael Lamberta 1, Lewis Nelson 3, 4. 1
Albert Einstein College of Medicine, Bronx, NY, USA; Jacobi Medical Center, Bronx, NY, USA; 3 New York City Poison Control Center, NY, USA; 2
4
375
Bellevue Hospital Center, NY, USA
E-mail address: [email protected].
Case Report: A 23 year old man with no past medical history presented to a suburban New York City hospital during April 2015 ten hours after sustaining a bite to his right eye from his pet Northern Pacific Rattlesnake (Crotalus oreganus, NPRS). On arrival he was somnolent. His vital signs were: BP 140/88 mmHg; HR 99/min: and oxygen saturation 100% on 2L NC. Physical exam revealed bilateral periorbital edema and ecchymosis greater on the right. The right globe appeared proptotic with chemosis and diffuse subconjunctival hemorrhage. Intraocular pressure was 18 mmHg and a positive Seidel test was noted. Initial laboratory testing revealed: lactate 3.1 mg/dL, potassium 5.6 mEq/L, platelets 13x103/mm3, PT 12.2 sec, INR 1.1. On repeat testing the potassium was 8 mEq/L, likely due to hemolysis. He was intubated for airway protection and treated for hyperkalemia. He was transferred to our regional snakebite center and received a total of 23 vials of ovine antivenom following current manufacturer recommendations. Repeat platelet count improved to 140x103mm3 and potassium to 5.3 mEq/L. Outpatient follow up revealed recurrent thrombocytopenia with a platelet count of 51x103mm3 daY 7 post envenomation. His platelet count normalized by day 13 without further intervention. Case Discussion: NPRS has a complex venom capable of causing significant local tissue damage and coagulopathy. This case is unique in that it demonstrates globe rupture after NPRS envenomation complicated by coagulopathy. The right eye underwent surgical repair but unfortunately vision in that eye was not preserved. Conclusion: To our knowledge this is the first report of globe rupture caused by NPRS envenomation. The coagulopathy responded to standard antivenom therapy but vision was lost in the injured eye. Keywords: Snakebite, Globe rupture
Venomous animal biology PARADOXICAL EXCEPTION TO ISLAND TAMENESS: INCREASED DEFENSIVENESS IN AN INSULAR POPULATION OF RATTLESNAKES Carl E. Person 1, Gerad A. Fox 1, Julie King 2, Eric C.K. Gren 1, Erick Briggs 3, William K. Hayes 1. 1 Department of Earth and Biological Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA; 2 Catalina Island Conservancy, Avalon, CA, USA; 3 Natural Solutions, Yucca Valley, CA, USA
E-mail address: [email protected].
Background: Island tameness exists among diverse animal taxa on islands worldwide, and results largely from a lack of natural predators. Several insular populations of rattlesnakes lack functional rattles, which has been interpreted as the consequence of relaxed selection arising from isolation and reduced predation. Accordingly, one might expect island populations of rattlesnakes to exhibit a decrement in defensive behavior relative to their mainland counterparts. Methods: We tested this hypothesis by comparing species-typical antipredator behaviors and venom expenditure during defensive bites by mainland (N ¼ 20) versus Santa Catalina Island, California, USA (N ¼ 10), populations of the dangerously venomous southern Pacific rattlesnake (Crotalus oreganus helleri). Results: Contrary to our prediction, rattlesnakes from the island not only lacked tameness compared to mainland snakes, but they also exhibited measurably greater levels of defensiveness. Island snakes attempted to bite 4.7 times more frequently as we endeavored to secure them by hand, and as a result they required 2.1-fold more time to be pinned and captured by hand compared to mainland snakes. When controlling for body size, the island snakes also delivered 2.1-fold greater quantities of venom when biting after being grasped. The additional venom resulted from 2.1-fold larger boluses of venom ejected from the fangs during a given bite. Relative head size was equal among snakes from the two populations, so differences in venom expenditure likely reflected behavioral decisions associated with risk assessment and level of defensiveness. No effect of duration in captivity (2e36 months) existed, which