Is the acute compartment syndrome diagnosed in snake bites true?: A review.

Envenomation caused by venomous snakes can induce clinical symptoms and signs resembling those of traumatic acute compartment syndrome (ACS), but it is uncertain whether its treatment guidelines are applicable or beneficial for ACS that is associated to snakebites. Nonetheless, recommendations for the diagnosis and treatment of trauma-induced ACS, particularly following fractures of the tibial diaphysis, are extrapolated to the diagnosis and treatment of snakebites despite evidence that the ensuing injuries are frequently not true ACS. Most biologists agree that the venom of snakes, especially those of the Crotalinae family (vipers) evolved to immobilize, kill, and initiate the digestion of their prey. The human local effects of viper envenoming are the result of digestion like those described in biological processes as acute pancreatitis, including secondary inflammatory and induction of reparative effects. The first-line treatment should focus on mitigation of venom-induced tissue digestion rather than surgery solution for "ACS-like" symptoms and signs. This type of analysis leads to questioning that treatment of ACS associated with snakebite cannot be extrapolated from recommendations formulated for trauma-induced ACS. The cornerstone of snake envenoming treatment is antivenom, and some clinical and experimental experiences start to show that surgical procedures frequently employed for trauma-induced ACS, such as debridement and fasciotomy, may be exaggerated and even deleterious in most viper bite envenoming.

Multiple Mononeuropathy following Crotalid Envenomation: A case report.

A 34-year-old man developed severe envenomation after being bitten by a Crotalus durissus (rattlesnake), which was treated with anticrotalic serum. Three weeks later, the patient reported paresthesia and neuropathic pain in the left hand, which had progressed to all four limbs. Electroneuromyography revealed asymmetric axonal sensorimotor multiple mononeuropathy. The patient was treated with prednisone, and six months later there was significant improvement in sensorimotor conduction. This is the first reported case of multiple mononeuropathy associated with C. durissus envenomation. Post-snake envenomation peripheral neuropathy is a rare complication requiring prompt recognition and treatment to optimize nerve function and enhance patient outcomes.

Oral varespladib for the treatment of snakebite envenoming in India and the USA (BRAVO): a phase II randomised clinical trial.

INTRODUCTION: Snakebite envenoming (SBE) results in over 500 000 deaths or disabling injuries annually. Varespladib methyl, an oral inhibitor of secretory phospholipase A2, is a nearly ubiquitous component of snake venoms. We conducted a phase II clinical trial to assess efficacy and safety of oral varespladib methyl in patients bitten by venomous snakes. METHODS: This double-blind, randomised, placebo-controlled trial enrolled patients in emergency departments in India and the USA. Patients with SBE were randomly assigned (1:1) to receive varespladib methyl or placebo two times per day for 1 week. All patients received standard of care, including antivenom. The primary outcome was change in the composite Snakebite Severity Score (SSS) measuring the severity of envenoming, from baseline to the average composite SSS at 6 and 9 hours. RESULTS: Among 95 patients randomised August 2021 through November 2022, the most common snakebites were from Russell's vipers (n=29), copperheads (n=18) and rattlesnakes (n=14). The SSS improved from baseline to the average at 6 and 9 hours by 1.1 (95% CI, 0.7 to 1.6) in the varespladib group versus 1.5 (95% CI, 1.0 to 2.0) in the placebo group (difference -0.4, 95% CI, -0.8 to 0.1, p=0.13). While key secondary outcomes were not statistically different by treatment group, benefit was seen in the prespecified subgroup initiating study drug within 5 hours of bite (n=37). For this early treatment group, clinically important differences were observed for illness severity over the first week, patient-reported function on days 3 and 7 and complete recovery. No death or treatment emergent serious adverse event occurred. CONCLUSION: For emergency department treatment of snakebites, the addition of varespladib to antivenom did not find evidence of difference for the primary outcome based on the SSS. A potentially promising signal of benefit was observed in patients initiating treatment within 5 hours of snakebite.

Prevention & management of snakebite envenomation: A qualitative study on perspectives & practices in Maharashtra & Odisha.

Background & objectives Snakebite envenoming (SBE) is a major public health concern, with India bearing the highest global burden of SBE-related deaths. SBE is concentrated in rural and tribal regions of India, where the knowledge, attitude and behaviour of the dwelling communities largely influence mortality and morbidity. Understanding these factors is crucial to designing effective SBE prevention and management strategies. The present study's objective was to document the perspectives of community members and practices in selected blocks of Maharashtra and Odisha States regarding SBE prevention, first aid and health-seeking behaviour. Methods Between March and April 2022, 28 focus group discussions (FGDs) were conducted. Study sites included Shahapur block in Thane district, Aheri block in Gadchiroli district of Maharashtra, and Khordha block in Khordha district, Kasipur block in Rayagada district of Odisha. Separate FGDs were held for males (n=14) and females (n=14), involving about 8-16 participants above 18 yr. All discussions were audio recorded, and a grounded theory approach was employed to identify key themes from the translated transcripts. Results The findings of this study revealed a variety of perspectives and practices determining the SBE burden at the study sites. The findings included insufficient knowledge about snake species and their nature of toxicity, use of non-scientific first aid techniques, inaccessible health care and reliance on traditional healers, non-utilization of prevention methods, varied cultural beliefs and practices, and differential treatments based on gender. The findings have been collated in two simplistic frameworks; barriers to effective prevention and barriers to effective management. Interpretation & conclusions SBE burden results from a complex interplay between socioeconomic, cultural, and demographic factors, necessitating a collaborative inter-sectoral effort for adequate control. Through crucial regional inputs and the barriers to prevention and management models, this study provides critical insights and priority intervention areas to strengthen India's upcoming National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE) in all high-burden States.

Myocardial infarction during treatment of Crotalinae envenomation: A case report.

While myocardial infarction is a rare, but known, potential side effect of snakebite envenomation, snake antivenom has thus far not been associated with any cardiovascular adverse events. We report the case of a 71-year-old man who developed an anterolateral MI during administration of Crotalidae immune F(ab')2 (equine) (ANAVIP), given as treatment for Crotalidae envenomation. The patient required cardiac catheterization with stenting of the left anterior descending artery and was discharged two days later on long-term clopidogrel and aspirin. Treatment of MI in the setting of envenomation should mirror typical management, with consideration of additional antivenom if the ischemia is determined to be venom-induced. Clinicians should have a high index of suspicion for patients with chest pain after snake envenomation or administration of antivenom.

Venom-induced myocarditis: An unusual case attributable to Vipera aspis bite.

Venomous bites are medical emergencies that may result in life-threatening clinical effects. Cardiovascular complications are uncommon but they can be dangerous if not early detected and treated. Cerebral and myocardial infarction are described; myocarditis as consequence of viper envenomation in humans are very rare, almost anedoctal. We present the case of a 33-year-old man, working as keeper in a reptile zoo, who arrived after a viper bite of the Vipera aspis species, on the left wrist. The patient presented with clouded sensorium, edema of the lips and tongue, rapidly worsened with angioedema, and the need for oro-tracheal intubation; severe thrombocytopenia and anemia were treated with transfusions of platelet, plasma and red blood cells. The left hand and arm worsened, with compartment syndrome, treated with surgical fasciotomy. From a cardiological point of view, the patient presented a sudden drop in blood pressure, electrocardiographic anterior and infero-lateral ST depression, pericardial effusion and hypokinesia of the interventricular septum on echocardiography, and a significant increase in troponin T. Cardiac magnetic resonance imaging confirmed the myocarditis, with the presence of septal and anterior intramyocardial edema in T2 weighted sequences, with prolonged T2 time at T2 mapping analysis, without late gadolinium enhancement areas. Cardiological and general clinical conditions gradually improved only after the antivenom was administred. This is one of the rare cases of viper bite myocarditis with echocardiographic and magnetic resonance imaging documentation in Europe; it emphasizes the importance of identifying uncommon complications of venomous snake-bites and the prompt administration of antivenom, even though snake bites are less frequent at our latitudes.

A case of Western Gaboon viper (Bitis rhinoceros) envenomation: Successful treatment with South African Institute for Medical Research (SAIMR) antivenom after North American crotalid antivenom failure.

We report a case of Western Gaboon viper (Bitis rhinoceros) envenomation in which the patient's symptoms progressed despite treatment with North American crotalid antivenom but improved after receiving South African Institute for Medical Research (SAIMR) polyvalent antivenom. A 59-year-old man was hospitalized after reportedly being bitten by a Gaboon viper (Bitis gabonica). On arrival, he had normal vital signs, two puncture wounds on his left hand, and edema distal to the wrist. The hospital contacted the local poison center who conveyed that crotalid antivenom would be ineffective and recommended transfer to a snakebite center for species-appropriate antivenom. However, this recommendation was disregarded. Initial laboratory tests 2 hours after envenomation revealed a platelet count of 77 x 109/L; other parameters were normal. He received six vials of crotalid antivenom (CroFab®) followed by three maintenance doses (total 12 vials). The next morning, swelling had progressed proximal to the elbow and platelets decreased to 37 x 109/L. He was subsequently transferred and received SAIMR polyvalent antivenom. Six hours later, his platelets were 130 x 109/L. The next morning, his swelling had significantly improved. He was discharged the following day. After discharge, it was discovered that the snake was a Bitis rhinoceros. Bitis gabonica and Bitis rhinoceros are popular captive snakes in the United States. Bitis rhinoceros was formerly a sub-species of B. gabonica, and they are often referred to interchangeably. Their venoms cause tissue edema, coagulopathy, and in severe cases, hemorrhage, dysrhythmias, and death. Antivenom is not widely available in the United States often necessitating patient transfer or antivenom delivery. This case addresses the question of whether crotalid antivenom, which is ubiquitous in the United States, can treat B. gabonica and B. rhinoceros envenomations and highlights the need for consultation with a poison center to facilitate administration of species-appropriate antivenom.

A retrospective observational study of mangrove pit viper envenomation presented to selangor middle zone cluster hospitals in Malaysia.

OBJECTIVE: There is very limited published experience on mangrove pit viper envenomation in the medical literature. This study aims to analyze the clinical characteristics, treatment modalities and outcomes of patients presenting to Selangor middle zone cluster Hospitals in Malaysia with confirmed mangrove pit viper bites. METHODS: We conducted a retrospective observational study, reviewing medical records of patients treated for mangrove pit viper bites between July 1, 2020 to June 30, 2023. Data on patient demographics, clinical characteristic, laboratory findings, treatment modalities and clinical outcomes were collected and analyzed. RESULTS: A total of 25 patients were included in this study. The majority of the patients were male (n = 23, 92%) with the mean age of 38.7 ± 17.6 years. Most frequent anatomical region involved is foot (n = 12, 48%). Common clinical presentation included localized pain (n = 24, 96%), swelling (n = 22, 88%) and fang mark (n = 22, 88%). Systemic symptoms were less common, with 1 patient exhibiting coagulopathy with clinical bleeding at 28 h post bite. Antivenom was administered to 68% (n = 17) of the patients. The majority of the patients (n = 23, 92%) recovered without significant morbidity while 8% (n = 2) of the patients developed skin infection that required antibiotic therapy. No fatalities were reported. CONCLUSION: Mangrove pit viper envenomation encountered in these regions predominantly causes local symptoms while systemic symptoms were less common. This study provides a glimpse to the clinical characteristics and management of mangrove pit viper envenomation, coagulopathy may be delayed due to characteristic of the snake venom and patient's preexisting illness. Further research is needed to enhance our understanding of this snakebite envenomation.

Colubrid snake envenomation: Erythrolamprus bizona "false coral" snakebite - clinical aspects and importance of identifying mimics.

Colubrids represent a diverse group of snakes historically regarded as harmless. With over 300 genera, the Colubridae family is the largest, encompassing approximately two-thirds of extant snake species. We describe a case of an 18-year-old male who suffered a colubrid snakebite from Erythrolamprus bizona, commonly known as the double-stranded coral snake mimic or false coral snake, which he misidentified as Lampropeltis sp., a fangless colubrid snake. Patient experienced localized erythema and edema, which later spread to the entire left hand along with moderate pain. Laboratory tests revealed leukocytosis and elevated creatine kinase. Symptoms resolved one week later. This case highlights the public health significance of ophidian accidents due to apparently "non-venomous snakes" or low-risk snakes such as the opisthoglyphous colubrid E. bizona. It also underscores the need to correctly identify and differentiate these snakes from other harmless colubrids, particularly double-stranded coral snake mimics in areas of geographic overlap and avoid their manipulation if uncertain of their taxonomic status.

Bites and Stings: Exotic Causes of Stroke in Asia.

BACKGROUND: Many unusual and fascinating causes of stroke are seen in Asia. Although rarely encountered in the Western world, such cases are seen not so infrequently by neurologists, physicians, and other healthcare workers in Asian countries. This article highlights some of these intriguing causes of stroke such as snakebite, scorpion stings, and bee and wasp stings. SUMMARY: Snakebite is a neglected tropical disease of global importance affecting over 5 million people each year, and scorpion stings and bee and wasp stings affect over a million people worldwide every year. Strokes due to these uncommon causes predominantly affect young males in their most productive years, and many victims die or remain with residual disability with significant socioeconomic consequences to the affected families and society. Both ischaemic and haemorrhagic strokes are seen, with ischaemic strokes being more common. Many unanswered questions remain regarding the pathophysiological mechanisms, clinical spectrum, and the natural history of stroke due to these causes. Antivenom is effective in snake envenoming, antivenom and prazosin are effective in scorpion envenoming, and treatment of anaphylaxis and allergy is recommended in systemic reactions due to bee or wasp stings. However, there are no treatment guidelines or expert recommendations to guide the management of stroke in these patients, and there are no data on the safety and efficacy of stroke-specific treatments such as antiplatelet therapy, thrombolysis or endovascular treatment. KEY MESSAGES: More research is clearly needed to unravel the complexities related to stroke following snakebite, scorpion envenoming, and bee and wasp stings, and to guide the development of optimal stroke treatment strategies in these unusual situations. Awareness of these exotic stroke aetiologies is important in early recognition and appropriate management of patients presenting with stroke symptoms in Asian countries, and in global travellers from the region. International collaborations would go a long way in improving our understanding of these rare but fascinating causes of stroke.

Taipan envenoming south of the border.

We present a case of severe taipan envenoming in northern New South Wales in a 68-year-old man. He developed severe neurotoxicity requiring intubation and ventilation, venom-induced consumption coagulopathy, myotoxicity and thrombotic microangiopathy with acute kidney injury requiring dialysis. He was administered brown and tiger snake antivenom consistent with guidelines and snake occurrence in the region. Taipan venom was detected in serum (72 ng/ml) following concern about the severity of neurotoxicity, clinical toxicology consultation and a concurrent report of a taipan in the area. Based on this it would be prudent to stock and consider treating with polyvalent antivenom in north-eastern New South Wales and south-eastern Queensland.

Multiple ventricular premature complexes following equatorial spitting cobra (Naja sumatrana) envenomation.

Naja species bite is the commonest cause for consultation to Remote Envenomation Consultancy Services in Malaysia. Envenomation by Naja species may result in neuroparalysis and cardiotoxic effects including arrhythmias, hypertension, tachycardia, atrioventricular blocks, ventricular tachycardia, and ventricular fibrillation. We report a case of cardiotoxicity as an early manifestation following an equatorial spitting cobra, Naja sumatrana bite, preceding early paralytic envenomation manifestation. A 14-year-old boy presented to an emergency department with mild local envenomation. ECG showed multiple ventricular premature complexes. Subsequently patient developed ptosis. Complete resolution of ptosis and resumption of normal sinus rhythm occurred following administration of the appropriate antivenom. The patient was discharged well after two days of hospitalization. The patient's ECG findings and neurotoxic manifestation suggested acute systemic envenomation. High index of suspicion for cardiotoxicity with close serial monitoring is recommended to ensure timely administration of antivenom.

Managing scorpion envenomations: A Gabes emergency department case study of 60 patients.

INTRODUCTION: Scorpion envenomation constitutes a major public health issue in Tunisia, especially in arid regions such as the Gulf of Gabes. It is necessary to understand the epidemiological and clinical characteristics of this condition and the importance of early management. AIM: This study aims to assess the epidemiological and clinical profile of patients admitted to the emergency department of Gabes University Hospital for scorpion envenomation, as well as the timing of management and intra-hospital evolution. METHODS: A retrospective descriptive study of 60 patients admitted for scorpion envenomation to the Acute Assessement unit at the Emergency Department of the Gabes University Hospital from January 2020 to January 2023. RESULTS: The average age was 35 years [1-85 years]. A slight male predominance (51.7%) was noted. Patients with chronic somatic diseases accounted for (25%) of our series. The predominant scorpion species was Androctonus australis (71.7%). The majority of incidents occurred during the nighttime (71.7%). Most patients were of rural origin (58.3%). The most common sting sites were the lower limbs (48.8%) and upper limbs (36.7%). Scorpion envenomation stages at admission were: Stage I (3.3%), Stage II (83.3%), and Stage III (8.33%). The average time to management was 2 hours. Patients classified as Stage II at admission or afterward were seen after an average of 3 hours. Patients initially classified as Stage III were seen after an average of 3 hours and 30 minutes, and those classified as Stage III during the hospitalization were seen after an average of 4 hours. The average time to management for patients transferred from the Emergency Department to the Intensive Care Unit was 4 hours. CONCLUSION: This study highlights the importance of early management of scorpion envenomation.

Successful use of anti-venom cross-neutralization effects in the clinical management of Shore Pit Viper envenomation.

As the landscape becomes more urbanized, snakebites have increasingly become uncommon presentations to the emergency departments in Singapore, while snakebites causing significant envenomation are even rarer. In this case report, we discuss a 55-year-old man who had significant envenomation from a Shore Pit Viper (Trimeresurus Purpureomaculatus) and who was successfully treated with haemato-toxic polyvalent antivenom (HPAV). He initially presented with pain, swelling and bleeding over his wound. Due to a deterioration in his coagulation profile, he was given two doses of HPAV which is typically reserved for viperid snakes instead. Following administration of the anti-venom, the patient's coagulation profile improved, and the local soft tissue effects of the venom resolved. He did not manifest any adverse effects and was discharged uneventfully about 72 h after the snakebite. The cross-neutralization potential of HPAV for Shore Pit Viper (Trimeresurus Purpureomaculatus) venom in this case study suggests that there may be a possible common underlying chemical structure and pathophysiology among the venom proteins of various snake species. Given that Trimeresurus-specific antivenom is unavailable in most countries, this cross-neutralization strategy deserves further consideration and evaluation in similar circumstances.

Composition, pharmacology, and pathophysiology of the venom of monocled cobra (Naja kaouthia)- a medically crucial venomous snake of southeast Asia: An updated review.

The Monocled Cobra (Naja kaouthia), a category one medically significant snake from the Elapidae family, inflicts severe envenomation in South and Southeast Asian countries. N. kaouthia is distributed throughout the eastern and northeastern parts of India, Nepal, Bangladesh, Myanmar, Thailand, Vietnam, Malaysia, and southwestern China. Envenomation by N. kaouthia is a medical emergency, and the primary clinical symptoms are neurotoxicity and localized tissue destruction. Unfortunately, data on the actual magnitude of N. kaouthia envenomation is scarce due to poor record keeping, lack of diagnostic kits, and region-wise well-coordinated epidemiological surveys. The present review highlights the diversity in the composition of N. Kaouthia venom (NKV) across various geographical regions, as revealed through biochemical and proteomic analyses. The qualitative and quantitative differences in the toxin isoforms result in differences in lethality and pathophysiological manifestation that may limit the effectiveness of antivenom therapy. Studies on commercial polyvalent antivenom (PAV) effectiveness against distinct NKV samples have revealed varying toxicity and enzymatic activity neutralization. Additionally, the identification of snake venom's poorly immunogenic toxins by mass spectrometry, quantification of venom-specific antibodies, and implications for antivenom therapy against snakebites are highlighted. Future directions involve clinical studies on NK envenomation where the snake is frequently encountered and the correlation of this data with NKV composition in that region. For more efficient and superior hospital management of NK envenomation, research should enhance the current immunization procedure to boost the development of antibodies against less immunogenic venom components of this snake.

Hypersensitivity vs. uncommonly severe local envenoming by the red-back spider, Latrodectus hasselti Thorell, 1870 (Araneae: Theridiidae).

The genus Latrodectus (Araneae: Theridiidae) consists of 35 widow spider species with global distribution. Envenoming by medically important species, latrodectism, commonly features bite site erythema and diaphoresis, variably severe pain that may be persistent, myalgia/cramping and/or myoclonus, autonomic symptoms, abdominal distress; severe envenoming can be prolonged and include serious effects such as oliguria, hypertension and, rarely, myocarditis/myocardial injury. Red-back spiders (Latrodectus hasselti) are the most common cause of envenoming in Australia and can cause the spectrum of effects noted for other medically important widow spiders. A 34-yr-old woman with a history of previous L. hasselti envenoming and treatment with antivenom was envenomed in her left ankle by a verified L. hasselti (hiding in her boot) while attending an appointment with her primary care physician. She reported some of the common effects of latrodectism including severe, prolonged pain, bite site diaphoresis, and malaise; however, she also developed marked edema that involved the entire left foot. She also exhibited mild hypertension and autonomic/non-specific effects limited to nausea, headache, and anxiety. She was effectively treated with red-back spider antivenom (a total of 4 ampoules) and supportive care; full resolution of the edema required almost 5 days. The uncommon clinical evolution of L. hasselti local envenoming observed in this patient may have been caused by a mixed picture of venom-induced effects and Type I hypersensitivity, but alternatively could be a rare, solely venom-induced manifestation. While provision of patient-centred care for anyone envenomed by Latrodectus spp. requires careful history collection and assessment of comorbidities, differentiation of atopic and direct venom effects may be challenging in some envenomed patients with established complex allergy history.

Evaluation of the International Society on Thrombosis and Haemostasis definition of major bleeding in Arizona rattlesnake bites.

INTRODUCTION: In 2023, a group of experts proposed that a definition of major bleeding in pharmaceutically anticoagulated patients be used in all snakebite trials. This includes bleeding that results in death, is life-threatening, causes chronic sequelae, or consumes major healthcare resources, including bleeding into a major area or hemoglobin concentration decrease ≥20 g/L. We hypothesized that a decline in hemoglobin concentration ≥20 g/L is common but rarely clinically significant in our population of Arizona rattlesnake bite patients. METHODS: Poison center records of rattlesnake bites in humans from 2018 through 2022 were retrospectively reviewed and assessed for major bleeding by the above criteria. RESULTS: Four hundred and eighty-one patients met the inclusion criteria, of whom 265 (55.1%) had a hemoglobin concentration decrease ≥20 g/L. No patients died, and there was no evidence of bleeding into a critical organ. Three patients (1.1%) received blood transfusions. A decrease in hemoglobin concentration ≥20 g/L was 100% sensitive for identifying the major bleeding-associated outcomes; however, specificity was only 45.2%. Measures of healthcare utilization and chronic sequelae were somewhat higher in patients with a decrease in hemoglobin concentration ≥20 g/L. DISCUSSION: Laboratory manifestations of hemotoxicity were common in this population, but hemorrhage was rare. While over half of patients met the major bleeding criterion of a decline in hemoglobin concentration ≥20 g/L, only 1.1% had bleeding that was potentially life-threatening as measured by receipt of a red blood cell transfusion. None died or had bleeding into a critical area. While nonspecific for major bleeding, a drop in hemoglobin concentration correlated with worse envenomation severity: these patients received more vials of antivenom, had a higher medical bill, a longer hospital stay, and were less likely to report full recovery at 90 days. CONCLUSIONS: A decrease in hemoglobin concentration ≥20 g/L should not be used as evidence of major bleeding for Arizona rattlesnake envenomation studies, but it may have a role as an indirect marker of envenomation severity.

A Randomized Controlled Trial to Optimize Antivenom Therapy for Carpet Viper (Echis romani)-Envenomed Children in Nigeria.

In an open randomized controlled trial, we compared one vial (10 mL) to two vials (20 mL) of EchiTAb-plus-ICP (EPI) antivenom among children with systemic carpet viper (Echis romani) envenoming of moderate severity in northeastern Nigeria. Systemic envenoming, presenting with incoagulable blood, was diagnosed using the 20-minute whole blood clotting test (20WBCT). Eligible patients with positive 20WBCT whose guardians assented were recruited and randomly allocated to receive either one vial or two vials of EPI administered either as a bolus or as a slow continuous infusion. The primary outcome was permanent restoration of blood coagulability 6 hours after the start of treatment, assessed by the 20WBCT and repeated at 6, 12, 24, and 48 hours after treatment. Secondary outcomes were the incidences of early adverse reactions to antivenom treatment. Initial doses permanently restored blood coagulability at 6 hours in 34/39 (87.2%) of those treated with one vial and 39/41 (95.1%) of those treated with two vials of EPI (P = 0.258). However, the proportion with permanent restoration of clotting at 6 hours among patients randomized to bolus administration was 41 of 42 (97.6%) patients compared with 32 of 38 (84.2%) patients randomized to slow infusion of EPI antivenom (P = 0.049); however, the difference was not sustained through the remaining time points. There was no difference in early adverse reactions between those treated with the two different doses or modes of delivery. We conclude that the one-vial dose compared favorably to two vials of EPI antivenom with regards to effectiveness and safety among children with carpet viper envenoming of moderate severity in Nigeria.

Enhancing snakebite management: The role of small molecule therapeutics in complementing antivenom strategies.

The variability in snake composition presents a significant challenge in accessing an effective broad-spectrum antivenom. These highly complex mixtures can result in numerous deleterious effects affecting thousands of individuals worldwide, particularly in Asia, sub-Saharan Africa, and Latin America. While the administration of antivenom remains a recommended treatment for snakebite envenomation and is the primary means to prevent systemic damage, there are limitations concerning specificity, reversal of local effects, and economic factors that hinder the availability of these antibodies. In this review, we have compiled information on the use of small molecule therapeutics in initial first-aid treatments before antivenom administration. These enzyme inhibitors have shown promise as viable candidates to broaden our treatment approaches, simplify procedures, reduce costs, and improve the clinical outcomes of affected patients.