Report of a severe Heloderma suspectum envenomation.

BACKGROUND: Heloderma bites are rare and generally mild, but a few cases can be life threatening. CASE REPORT: We report a case of Heloderma suspectum envenomation in a healthy 39-year-old herpetologist. The patient rapidly developed tongue and lip swelling associated with stridor. On arrival at ICU, he was hypotensive, and in shock with atrial fibrillation requiring electrical cardioversion. Blood tests showed hypokalemia (2 mmol·L-1), associated with moderate low blood electrolytes which were corrected rapidly. In addition, he presented hematological abnormalities (INR = 1.34 and fibrinogen levels at 80 mg·dL-1) without active bleeding. All clinical and biological signs normalized without specific intervention and was discharged 4 days post-bite. The patient discharged 3 days after hospital presentation and fully recovered in 2 months. DISCUSSION/CONCLUSION: The case presented here showed the three severe complications described after Heloderma bite: a) angioedema, b) fluid loss associated with hypokalemia and metabolic acidosis, and c) cardiac disorders simulating ischemia.

Landscape of research, production, and regulation in venoms and antivenoms: a bibliometric analysis / Panorama de la investigación, la producción y la regulación de venenos y antivenenos: un análisis bibliométrico / Panorama de pesquisa, produção e regulação de venenos e antivenenos: análise bibliométrica

ABSTRACT Objectives. To assess the productivity and visibility in research, clinical studies, treatment, use and production of antivenoms against poisonous snakes, scorpions and spiders. Methods. Bibliometric analysis of research and other activities. Articles on venoms and antivenoms published between 2000 and 2020 were retrieved from the Scopus database. The records were analyzed by bibliometric indicators including number of documents per year, journals, authors, and citation frequency. VOSviewer® v.1.6.13 was used to construct bibliometric networks for country co-authorships and co-occurrence of terms. Results. Australia, Brazil, Costa Rica and India were among the six top countries with most documents and were selected for more detailed analysis. Costa Rica was the country with the largest percentage of its publications dedicated to antivenom production and venomics. Only a few papers dealt with the issues of quality, safety, and efficacy of antivenoms or the role of the national regulatory authorities. The use of VOSviewer® allowed visualization through joint publications of networking between countries. Visualization by co-occurrence of terms showed differences in the research carried out. Conclusions. Working in a collaborative and coordinated manner these four countries could have a major impact on envenoming globally. Attention should be given not only to antivenom production but also to strengthening regulatory oversight of antivenom products.

RESUMEN Objetivos. Evaluar la productividad y la visibilidad en la investigación, los estudios clínicos, el tratamiento, el uso y la producción de antivenenos contra las picaduras de serpientes, arañas y escorpiones venenosos. Métodos. Análisis bibliométrico de la investigación y de las otras actividades. Se tomaron los artículos sobre venenos y antivenenos publicados entre el 2000 y el 2020 en la base de datos de Scopus. Estos documentos se analizaron mediante indicadores bibliométricos como el número de documentos por año, revistas, autores o frecuencia en las citas. Se utilizó VOSviewer® v.1.6.13 para crear una red bibliométrica para coautorías de países y coapariciones de términos. Resultados. Australia, Brasil, Costa Rica e India estaban entre los seis primeros países con más documentos y se seleccionaron para un análisis más detallado. Costa Rica fue el país con el mayor porcentaje de sus publicaciones dedicadas a la producción de antivenenos y la venómica. Solo unos pocos artículos trataban los temas de la calidad, la seguridad y la eficacia de los antivenenos, o la función de las autoridades regulatorias nacionales. Gracias a VOSviewer® pudimos visualizar las publicaciones conjuntas de las colaboraciones entre países. La visualización por la coaparición de términos arrojó diferencias en la investigación realizada. Conclusiones. Si estos cuatro países trabajasen de forma colaborativa y coordinada, podrían tener una repercusión mayor en los envenenamientos por picaduras en el mundo. El foco no debe ponerse solo en la producción de antivenenos, sino también en fortalecer la supervisión regulatoria de estos productos.

RESUMO Objetivos. Avaliar a produtividade e visibilidade em pesquisa, estudos clínicos, tratamento, uso e produção de antivenenos contra peçonhas de serpentes, escorpiões e aranhas. Métodos. Análise bibliométrica de pesquisas e outras atividades. Artigos sobre venenos e antivenenos publicados entre 2000 e 2020 foram obtidos da base de dados Scopus. O conteúdo foi analisado segundo indicadores bibliométricos, como número de artigos por ano, periódicos, autores e frequência de citação. Utilizou-se o software VOSviewer® v.1.6.13 para construir redes bibliométricas de coautoria de países e co-ocorrência de termos. Resultados. Austrália, Brasil, Costa Rica e Índia figuraram entre os seis principais países com o maior número de artigos e, assim, foram selecionados para uma análise mais aprofundada. A Costa Rica teve a maior porcentagem de publicações dedicadas à produção de antivenenos e pesquisa em venômica. Apenas um pequeno número de artigos tratou de questões relacionadas à qualidade, segurança e eficácia dos antivenenos ou ao papel das autoridades nacionais reguladoras. O software VOSviewer® permitiu visualizar, através das publicações conjuntas, as redes formadas entre diferentes países. A visualização por co-ocorrência de termos revelou diferenças nas pesquisas realizadas. Conclusões. Trabalhando de forma colaborativa e coordenada, esses quatro países tiveram uma influência importante em nível mundial no campo de acidentes por animais peçonhentos. Deve-se atentar não apenas à produção de antivenenos, mas também ao fortalecimento da fiscalização regulatória destes.

Protective effect of Dracontium dubium against Bothrops asper venom.

In Colombia, Bothrops asper is responsible for 70-90% of ophidians accidents reported annually. Envenoming occurs mainly in rural areas where both antivenom and health centers are scarce. Thus, patients are frequently treated by local healers that employ medicinal herbs; including several species belonging to Dracontium genus. In this work, we evaluated the neutralizing activity of Dracontium dubium Kunth against the lethal, inflammatory, coagulant and hemolytic effects produced by B. asper venom. Mice treated with D. dubium extract (500 and 1000µg/g, ip), survived to the administration of lethal doses of venom, with remarkable recovery of macroscopic and histology damage. Furthermore, D. dubium exerted a significant inhibition of inflammatory damage promoted by paw injection of B. asper venom. Such activity might be related to the inhibition of macrophage activation and NO production, as demonstrated using LPS-stimulated RAW 264.7 cells. Moreover, the extract of D. dubium remarkably diminished the indirect hemolytic effect of snake venom. On the other hand, no substantial differences were observed in clotting time of plasma incubated with venom when compared to extract treated plasma. Noteworthy, D. dubium extract did not alter the electrophoretic pattern of venom before the assays. Phytochemistry screening revealed the presence of phenolic compounds, flavonoids, tannins and steroids/triterpenoids, which might explain the bioactivity of the extract. Our results, provides strong evidence that support the employment of D. dubium in folk medicine. Further studies are needed to isolate and identify the metabolites responsible for the activity, in order to provide a useful and accessible treatment for snakebite envenoming in low-income rural areas.

Poison exposures in young Israeli military personnel: a National Poison Center Data analysis.

CONTEXT: To characterize poison exposures in young Israeli military personnel as reported to the national poison center. METHODS: Retrospective poison center chart review over a 14-year period. Cases included were Israeli soldiers aged 18-21 years, the compulsory military service age required by the Israeli law. RESULTS: 1770 records of poison exposures in young military personnel were identified. Most exposed individuals involved males (n = 1268, 71.6%). Main routes of exposure were ingestion (n = 854, 48.3%), inhalation (n = 328, 18.6%) and ocular (n = 211, 11.9%). Accidents or misuse (n = 712, 40.2%) were the most frequently reported circumstances, followed by suicide attempts (370, 20.9%), and bites and stings (161, 9.1%). More than half of the cases involved chemicals (n = 939, 53.1%); hydrocarbons, gases and corrosives were the main causative agents. Pharmaceuticals (mainly analgesics) were involved in 519 (29.3%) cases, venomous animals (mainly scorpions, centipedes, and snakes) in 79 (4.5%). Clinical manifestations were reported in 666 (37.6%) cases, mostly gastrointestinal, neurologic, and respiratory. The vast majority of cases (1634, 92.3%) were asymptomatic or mildly affected; no fatalities were recorded. In 831 (46.9%) cases the clinical toxicologist recommended referral to an emergency department; ambulatory observation was recommended in 563 (31.8%) cases, and hospitalization in 86 (4.9%). CONCLUSIONS: Our data show that poison exposures among young soldiers involve mainly males, accidents, misuse and suicides, oral route and chemicals; most exposures were asymptomatic or with mild severity. Repeated evaluations of poison center data pertaining to military personnel is advised for identifying trends in poison exposure and characteristics in this particular population.

A nationwide study of patients hospitalised for poisoning in Korea based on Korea National Hospital Discharge In-Depth Injury Survey data from 2005 to 2009.

OBJECTIVES: In light of the need to develop an integrated database on poisoning incidents in Korea, this study seeks to determine the characteristics of poisoning incidents in Korea by age, gender, location of incident, causative substance and patient prognosis. DATA SOURCES: The Korea National Hospital Discharge In-Depth Injury Survey results (2005-2009) from the Korea Centers for Disease Control and Prevention were used. PARTICIPANTS: 3826 participants in the survey who had been hospitalised for poisoning incidents. RESULTS: The poisoning hospitalisation rate per 100,000 population was higher in women (1.735) than in men (1.372) and increased with age: the rate was 0.458 among individuals aged ≤9 years, 0.481 among those aged 10-19 years, 1.584 among those aged 20-64 years and 4.053 among those aged ≥65 years. The intentional poisoning hospitalisation rate differed by gender and age group. Women aged ≤19 years and 20-64 years showed a higher hospitalisation rate than men, while men aged ≥65 years showed a higher hospitalisation rate than women in the same age group. The most common poisoning substance was pesticides (33.6%), while antiepileptic, sedative-hypnotic and antiparkinsonism drugs and psychotropic drugs, not elsewhere classified were also very common. Poisoning in those aged ≤9 years usually involved other drugs, while pesticides were the most common substances in those aged 20-64 years and ≥65 years. CONCLUSIONS: This study analysed poisoning incidents in Korea from 2005 to 2009, by age and gender, causative substance, and characteristics. The results of this study may serve as evidence for new strategies in Korea to prevent poisoning.

Anaphylactic shock caused by sting of crown-of-thorns starfish (Acanthaster planci).

A 40s-year-old woman with previous history of injury due to contact with crown-of-thorns starfish, Acanthaster planci, was stung on the right middle finger. After immediately losing consciousness, she died 13 h after injury despite intensive medical treatment. Examination of the respiratory system revealed narrowing due to severe edema of the laryngopharynx, as well as alveolar hemorrhage, eosinophilic infiltration, and extensive neutrophil and eosinophil aggregation in the intravascular lumen of the lungs. Examination of the liver revealed severe diffuse hepatocellular necrosis and extremely high levels of liver transaminases, indicating severe liver damage. Based on these findings, we concluded that she had died from anaphylactic shock induced by circulation of crown-of-thorns starfish venom in the bloodstream. Injurious contact with the spine of the crown-of-thorns starfish can cause severe symptoms as well as systematic reactions, including anaphylaxis. To our knowledge, this is the first case of anaphylactic shock or death caused by human contact with the crown-of-thorns starfish reported in the English-language literature. Although rare, anaphylaxis due to injury by marine animals is potentially fatal. Saving lives requires providing education regarding prevention and enabling prompt response to possible anaphylaxis, including preparation of adrenaline for auto-injection.

Venomous bites, stings, and poisoning.

This article discusses the epidemiology, prevention, clinical features, first aid and medical treatment of venomous bites by snakes, lizards, and spiders; stings by fish, jellyfish, echinoderms, and insects; and poisoning by fish and molluscs, in all parts of the world. Of these envenoming and poisonings, snake bite causes the greatest burden of human suffering, killing 46,000 people each year in India alone and more than 100,000 worldwide and resulting in physical handicap in many survivors. Specific antidotes (antivenoms/antivenins) are available to treat envenoming by many of these taxa but supply and distribution is inadequate in many tropical developing countries.

Gila monster bite.

A 29-year-old man was bitten on the forearm by a wild Gila monster. Radiographs demonstrated subcutaneous air. During a period of observation, erythema and edema progressed from the forearm to the axilla and he developed a significant leukocytosis. No purulence was found upon surgical evaluation. We hypothesize that air was introduced into the wound by the "pulsing," chewing-like action that the Gila monster made while it was attached to the man's forearm.

Aspectos clinicopatológicos e laboratoriais do envenenamento experimental por Bothrops moojeni e Bothropoides neuwiedi em ovinos / Clinicopathological and laboratory aspects of experimental poisoning by Bothrops moojeni and Bothropoides neuwiedi snake venoms in sheep

O envenenamento ofídico espontâneo, ou acidente ofídico, é descrito como causa de morte em animais domésticos. No entanto, dados concretos relativos ao gênero e espécie de serpente envolvida, à evolução do quadro clínico, e às alterações clinicopatológicas desenvolvidas, são escassos. Assim sendo, este trabalho teve como objetivo determinar as alterações clinicopatológicas e laboratoriais provocadas pelo veneno de Bothrops moojeni e Bothropoides neuwiedi em ovinos no intuito de fornecer informações adicionais referentes a acidentes ofídicos em animais de produção, auxiliando o estabelecimento do diagnóstico dessa condição. Os venenos liofilizados foram diluídos em 1 ml de solução fisiológica e administrados a quatro ovinos por via subcutânea na face direita, nas doses de 0,41mg/kg e 0,82mg/kg do veneno de B. moojeni em dois ovinos, e de 1,0mg/kg do veneno de B. neuwiedi em dois ovinos. Apenas o ovino que recebeu a menor dose (0,41mg/kg) sobreviveu, apesar de ter desenvolvido quadro clínico muito severo e semelhante aos demais. Os sinais clínicos iniciaram nos primeiros 10 minutos após a inoculação em todos os ovinos. O período de evolução variou de dois a quatro dias. O quadro clínico dos quatro ovinos caracterizou-se por apatia, acentuado aumento de volume da face, da porção ventral do pescoço e do peito, leve aumento de volume da porção proximal dos membros anteriores, tempo de sangramento aumentado, taquicardia, mucosas pálidas e grande quantidade de sangue não digerido nas fezes. Ao exame laboratorial observou-se principalmente redução das proteínas plasmáticas e aumento de creatinaquinase em todos os ovinos. À necropsia, foram observados extensos hematomas nas áreas correspondentes ao aumento de volume subcutâneo. Observaram-se petéquias, equimoses e sufusões leves a moderadas na serosa de diversos órgãos e acúmulo de sangue em meio às fezes na porção final do reto. Além de hemorragias, a principal alteração histopatológica observada foi necrose das fibras musculares esqueléticas e da parede de vasos, nas áreas próximas à inoculação do veneno. Nos ovinos deste estudo o aumento de volume, observado na face, pescoço, peito e membros, era constituído por sangue.

Spontaneous envenoming by snake bite is described as a cause of death in domestic animals. However, there are just few information about the species of snake involved, course, and clinicopathological and laboratory findings. Thus, this research aimed to determine the clinicopathological and laboratory changes induced by Bothrops moojeni and Bothropoides neuwiedi snake venoms in sheep, in order to provide additional information regarding snakebites in farm animals and to help establish the diagnosis of this condition. The lyophilized snake venoms were dissolved in 1mL saline solution and administered subcutaneously into the right face of four sheep, at doses of 0.41mg/kg and 0.82mg/kg of B. moojeni venom for two sheep, and 1.0mg/kg of B. neuwiedi venom for two other sheep. Only the sheep which had received the lowest dose (0.41mg/kg) survived, but developed severe clinical signs, similar to the others. First clinical signs were observed about 10 minutes after inoculation in all sheep. The course varied from 2 to 4 days. The clinical findings in all sheep were characterized by apathy, marked swelling of the face, the ventral neck and esternal region, and mild swelling of the proximal portion of the forelimbs, as well as increased bleeding time, tachycardia, pale mucous membranes, and large quantity of undigested blood in the intestinal lumen. Laboratory exams showed mainly a reduction in serum protein and increased creatine kinase in all sheep. At necropsy, extensive hematomas were observed in the subcutaneous tissue of the swollen areas. Also petechiae, bruises and mild to moderate hemorrhagic suffusions on the serosa of various organs, and blood within the intestinal contents of the distal rectum were observed. In addition to hemorrhages, the main histopathological changes were necrosis of skeletal muscle fibers and blood vessel walls next to the inoculation site. The swollen areas on face, neck, sternum and limbs of the sheep were due the hematomas.

Animal-related fatalities--part I: characteristic autopsy findings and variable causes of death associated with blunt and sharp trauma.

Animals may be responsible for an array of potentially lethal injuries. Blunt force injuries characteristically involve larger animals such as cattle or horses that may kick, crush, or trample a victim causing head and facial injuries. Farm workers in particular are at high risk of lethal injuries involving the head and torso. Significant blunt trauma may be found in vehicle occupants after collisions with large animals such as camels or moose. Rarely, zookeepers may be crushed by particularly massive animals such as elephants. Sharp force injuries usually involve carnivore bites, most often from dogs with a "hole and tear" pattern of wounding. Injuries from animals such as alligators and sharks may have a significant component of crushing. Incised wounds may result in death from exsanguination and air embolism. On occasion, blunt or sharp trauma from animal activity may be confused with postmortem damage or with inflicted injury from an assault.

Animal-related fatalities--part II: characteristic autopsy findings and variable causes of death associated with envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis.

In addition to blunt and sharp trauma, animal-related fatalities may result from envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis. Although the majority of envenomation deaths are caused by hornets, bees, and wasps, the mechanism of death is most often anaphylaxis. Envenomation resulting from the injection of a poison or toxin into a victim occurs with snakes, spiders, and scorpions on land. Marine animal envenomation may result from stings and bites from jellyfish, octopus, stonefish, cone fish, stingrays, and sea snakes. At autopsy, the findings may be extremely subtle, and so a history of exposure is required. Poisoning may also occur from ingesting certain fish, with three main forms of neurotoxin poisoning involving ciguatera, tetrodotoxin ingestion, and paralytic shellfish poisoning. Asphyxiation may follow upper airway occlusion or neck/chest compression by animals, and sepsis may follow bites. Autopsy analysis of cases requires extensive toxinological, toxicological, and biochemical analyses of body fluids.

Predição da neutralização do efeito coagulante da peçonha de Bothrops pauloensis pelo extrato aquoso de Hedychium coronarium (Zingerberaceae) através de modelos de regressão / Prediction of neutralization of clotting effect of venom bothrops pauloensis by aqueous extract of hedychium coronarium (zingeberaceae) through of regression models

Envenenamentos com serpentes do gênero Bothrops podem causar sequelas no local da picada, que não são revertidas mesmo após o tratamento com soro antiofídico. A incubação do extrato aquoso de Hedychium coronarium (Zingeberaceae) com a peçonha da serpente Bothrops pauloensis em diferentes concentrações foi capaz de inibir a atividade coagulante. No presente trabalho ajustou-se um modelo de regressão entre níveis de concentração de extrato e tempo de coagulação (segundos). O modelo ajustado conseguiu captar cerca 96 % da variação total do tempo de coagulação.

Envenomations with snakes Bothrops genus can cause dependency at the sting site, which are not reversed even after treatment with snake antivenoms. Incubation of the aqueous extract of Hedychium coronarium (Zingeberaceae) with snake venom Bothrops pauloensis in different concentrations was able to inhibit some enzymatic activities. This work has set a model of regression between concentrations of extract and clotting time (seconds). The adjusted model has captured about 96% of the total variation of clotting time

Emergencia hipertensiva en emponzoñamiento escorpiónico pediátrico: reporte de un caso / Hipertensive emergency in pediatric scorpion envenomation: case report

Se reporta el caso clínico de una niña de 2 años, quien posterior a picadura por escorpión en el brazo izquierdo, presentó náuseas, vómitos, sialorrea e hipertensión arterial, a pesar de la administración precoz de suero antiescorpiónico y captopril. Al día siguiente, debido a la emergencia hipertensiva, desarrolló varias crisis convulsivas tónicas generalizadas, refractarias a diazepam y controladas con difenilhidantoína en infusión por 24 horas; la emergencia hipertensiva se prolongó por 10 días y se trató con captopril, nifedipina y carvedilol por vía oral. Este cuadro clínico se acompañó con miocarditis, pancreatitis y una reacción adversa medicamentosa a la antivenina escorpiónica. Otros fármacos administrados fueron corticoesteroides, midazolam y fentanilo. La evolución fue satisfactoria y la niña fue egresada en buenas condiciones generales dos semanas después del ingreso. Este caso se muestra con características infrecuentes como la concomitancia de los patrones miocárdico y cardiovascular, la severidad del patrón vascular, la duración de la emergencia hipertensiva, la falta de efectividad de captopril y del suero antiescorpiónico y la reacción adversa a la antivenina.

We report the clinical case of a 2 year old girl, who developed nausea, vomiting, increased salivation and arterial hypertension, after ascorpion sting in her left arm, despite the early administration of scorpion antivenom and captopril. Next day, due to a hypertensive emergency, the patient developed generalized tonic seizures, refractory to diazepam, which were controlled with an infusion of dyphenilhydantoine for 24 hours. The hypertensive emergency extended for 10 days and was treated with oral captopril, nifedipine and carvedilol. This clinical picture was accompanied with myocarditis, pancreatitis and an adverse drug reaction to the anti venom. Other drugs administered were corticosteroids, midazolam and fentanyl. The Outcome was satisfactory and the girl was discharged in good general conditions, two weeks after admission. This case appears with uncommon features, such as the occurrence of myocardic and cardiovascular patterns, severity of vascular pattern, the duration of the hypertensive emergency, ineffectiveness of captopril and the scorpion antivenom, and the adverse reaction to antivenin.

High-molecular weight protein toxins of marine invertebrates and their elaborate modes of action.

High-molecular weight protein toxins significantly contribute to envenomations by certain marine invertebrates, e.g., jellyfish and fire corals. Toxic proteins frequently evolved from enzymes meant to be employed primarily for digestive purposes. The cellular intermediates produced by such enzymatic activity, e.g., reactive oxygen species or lysophospholipids, rapidly and effectively mediate cell death by disrupting cellular integrity. Membrane integrity may also be disrupted by pore-forming toxins that do not exert inherent enzymatic activity. When targeted to specific pharmacologically relevant sites in tissues or cells of the natural enemy or prey, toxic enzymes or pore-forming toxins even may provoke fast and severe systemic reactions. Since toxin-encoding genes constitute "hot spots" of molecular evolution, continuous variation and acquirement of new pharmacological properties are guaranteed. This also makes individual properties and specificities of complex proteinaceous venoms highly diverse and inconstant. In the present chapter we portray high-molecular weight constituents of venoms present in box jellyfish, sea anemones, sea hares, fire corals and the crown-of-thorns starfish. The focus lies on the latest achievements in the attempt to elucidate their molecular modes of action.

Venomous animals: clinical toxinology.

Venomous animals occur in numerous phyla and present a great diversity of taxa, toxins, targets, clinical effects and outcomes. Venomous snakes are the most medically significant group globally and may injure >1.25 million humans annually, with up to 100 000 deaths and many more cases with long-term disability. Scorpion sting is the next most important cause of envenoming, but significant morbidity and even deaths occur following envenoming with a wide range of other venomous animals, including spiders, ticks, jellyfish, marine snails, octopuses and fish. Clinical effects vary with species and venom type, including local effects (pain, swelling, sweating, blistering, bleeding, necrosis), general effects (headache, vomiting, abdominal pain, hypertension, hypotension, cardiac arrhythmias and arrest, convulsions, collapse, shock) and specific systemic effects (paralytic neurotoxicity, neuroexcitatory neurotoxicity, myotoxicity, interference with coagulation, haemorrhagic activity, renal toxicity, cardiac toxicity). First aid varies with organism and envenoming type, but few effective first aid methods are recommended, while many inappropriate or frankly dangerous methods are in widespread use. For snakebite, immobilisation of the bitten limb, then the whole patient is the universal method, although pressure immobilisation bandaging is recommended for bites by non-necrotic or haemorrhagic species. Hot water immersion is the most universal method for painful marine stings. Medical treatment includes both general and specific measures, with antivenom being the principal tool in the latter category. However, antivenom is available only for a limited range of species, not for all dangerous species, is in short supply in some areas of highest need, and in many cases, is supported by historical precedent rather than modern controlled trials.

New Zealand's venomous creatures.

AIM: New Zealand is home to a small number of venomous creatures. The purpose of this review is to educate and update healthcare professionals on the management of envenoming from these creatures. METHODS: An extensive literature review was performed by systematically searching OVID MEDLINE and ISI Web of Science. In addition, further information was obtained from book chapters, relevant news reports, and web material. RESULTS: The signs and symptoms resulting from envenoming of clinically significant venomous creatures found in New Zealand are discussed. Definitive medical treatment recommendations are made. CONCLUSION: Encounters with New Zealand's few venomous creatures, while rarely fatal, can cause significant morbidity. Effective management can be achieved by informed health professionals having regard to the principles outlined in this review.

Emponzoñamiento escorpiónico: manejo de las manifestaciones cardiovasculares: Hospital Universitario de Pediatría Doctor Agustin Zubillaga de Barquisimeto-estado Lara-Venezuela / Scorpion envenomation: management of cardiovascular manifestations: Dr. Agustin Zubillaga Pediatric Hospital of Barquisimeto-Lara state-Venezuela

Se presentan características clínicas, epidemiológicas y taxonómicas del emponzoñamiento escorpiónico en Venezuela. Se revisan aspectos de la fisiopatología de la venina en el área cardiovascular y las bases racionales del tratamiento. Finalmente, se presentan las pautas del protocolo del Centro Toxicológico Regional "Dra. EL Bermúdez" para la terapia del emponzoñamiento escorpiónico en el Hospital pediátrico "Dr. Agustin Zubillaga".

Clinical, epidemiological and taxonomic features about scorpion envenoming in Venezuela are presented. Aspects about physiopatology of the venom in the cardiovascular area and the rationale of the treatment are reviewed. Finally, the guidelines of "Dra. EL bermúdez" Regional Poison Center for therapy of the scorpion envenoming in "Dr. Agustin Zubillaga" Pediatric Hospital are presented.

A pilot study of occupational envenomations in North American zoos and aquaria.

OBJECTIVE: To characterize occupational envenomations from exotic and native creatures, we surveyed North American zoos and aquaria. METHODS: Survey questionnaires were mailed to curators at 216 zoos/aquaria which are accredited by the Association of Zoos and Aquariums (AZA) and listed on the AZA website. Reptile curators were asked to complete the zoo surveys. The questions addressed the number and types of bites, availability of antivenom (AV) on the premises, and sources of general information about envenoming. Responses were kept anonymous. RESULTS: A total of 216 surveys were mailed. The response rate was 58% for this pilot research project. Twenty-six (21%) of responding institutions replied that they had at least one incident of bite from a venomous species in the last 10 years. Species of animals included a variety of native and exotic terrestrial and marine species. There were no deaths or serious outcomes reported as complications of these incidents. Less than one-third of responding institutions reported having AVs on-site for medical use in case of envenomations. A variety of information sources, including internally developed protocols and poison center resources, were reported as sources of envenoming information for respondents. CONCLUSIONS: Clinicians and toxicologists should be prepared to care for cases of envenomations from exotic zoo or aquarium species such as the ones identified in this survey in their practice regions.