2022/04/04, 09:18 - Douw Grobler: Dear All A stiletto snake bit my friend's son on the tip of his finger. I thought it would be cytotoxic, and would need huge doses of antibiotics and anti-inflammatories and cortisone. This turns out to be wrong. I include a message from Johan Marais, who is the best in the business for treating snake bites and identifying snakes. I will post his number as well if ever it is needed. From Johan Marias : The stiletto snake has a a potent cytotoxic venom, causing local damage. Symptoms that are seen include swelling, pain, blistering and tissue damage. This is not covered by the polyvalent antivenom - treat as little as possible in first 4-5 days. Avoid surgical intervention - give painkillers, IV fluids, but no antibiotics, anti-inflammatories or cortisone. Be careful of anti- inflammatories - with cytotoxic venom, it makes it worse. The wound generally recovers well within 2-3 days. Decide by days 6-7 whether any surgery necessary, or even amputation. For information on first aid for snakebite and snake removals, please download the free African Snakebite Institute App ASI Snakes (http://bit.ly/snakebiteapp). Have a look at the paper by Branch & Tilbury (Burrowing Asp). 2022/04/04, 09:37 - Ampie Viljoen: Excellent app and amazing how quickly they give you feedback on questions and identification 2022/04/04, 09:55 - Marius Louw: I've used it more than once with good success 2022/04/04, 09:58 - Andy Fraser: Snake bite emergencies: 2022/04/04, 10:36 - Douw Grobler: From Johan Marais : That is out of date. The number for the Tygerberg Poison Centre no longer exists - the correct number is 0861555777. Rinkhals venom is far more cytotoxic than neurotoxic - we never need to intubate and ventilate patients but see a fair amount of tissue damage. The Coral Snake (Aspidelaps lubricus lubricus) occurs in the Western Cape. We do not have Egyptian Cobras (they occur from Egypt to Kenya) but we do have the Snouted Cobra (Naja annulifera) that used to be a subspecies of the Egyptian Cobra but no longer). Morphine is suggested - not a good idea for neurotoxic bites where breathing is compromised. For neurotoxic and cytotoxic bites they recommend 40-80 ml of polyvalent antivenom. The current protocol is around 5-6 vials initially for Puff Adder bites but for neurotoxic bites as well as Mozambique Spitting bites an initial dosage of 100-120 ml is recommended. Under Part B Algorithm they recommend that one identifies the venom - this is not possible as we do not have such a test in Africa **. 2022/04/04, 10:36 - Douw Grobler: (Johan Marais). For Boomslang bites they recommend 40 ml of monovalent antivenom - the standard protocol is 20 ml. Fab AV is mentioned - not available in South Africa. Under monovalent antivenom on the dosage chart, they mention 4-8 vials for Boomslang bites. We have never used more than 3 vials! This protocol is outdated and should not be used. 2022/04/04, 11:01 - Andy Fraser: Snakebites: 2022/04/04, 11:01 - Andy Fraser: There's a lot of good info on there. It's graphic and easy to understand. **identify the venom means differentiate between neuro/cyto/haemo or combinations thereof. 2022/04/04, 11:06 - Simone Herzog: For those in Namibia: in case of snakebite contact Dr. Christo Buys by WhatsApp or email. https://www.facebook.com/groups/187156948143224/permalink/187209114804674/?sfnsn=mo&ref=shares. Email: snakebitedoc@gmail.com 2022/04/04, 12:34 - Louis Greeff : Douw, can you ask Johan to send a new version for us. I also like Andy's version, it is very helpful. 2022/04/04, 12:45 - Louis Greeff : Out of interest, we see every now and then dogs bitten by boomslang. Monovalent antivenom is very expensive and not easy to obtain.....if you can find it, they usually don't want to give it if it is for animal use. We put the animals on Ringers Lactate drip with Vit. K and tranexamic acid, and also give high doses of cortisone and anti-inflammatories. We also give whole blood transfusion. Sometimes a dog needs two to three transfusions to stop bleeding. We usually give a transfusion and wait until it starts again before we start the next transfusion. It usually ends up being a transfusion daily for three consecutive days. We work on 10 ml whole blood per kg. It is also good to collect your blood from one dog. We usually take a 60 or 70kg boerboel and draw two bags or one and a half bag. It helps to give the same blood to the bitten dog - you don't get that severe reactions on the second and third transfusion. 2022/04/04, 12:48 - Raoul Strydom: We have also treated 2 dogs successfully as described by Louis above. 2022/04/04, 13:30 - Henry Labuschagne: I use whole blood for first transfusion and mostly PRP for follow up transfusions depending on RBC count. I also dose with Sucrulfate to act as a plaster in GIT. I avoid NSAIDs and only use cortisone. 2022/04/04, 13:33 - Douw Grobler: (Johan Marais) Unfortunately, treatment can't put it into a simple diagram. Treating snakebite is a little too complex to summarise it on an anogram. 2022/04/04, 13:34 - Douw Grobler: (Johan Marias.) Sorry, but have to disagree about the treatment of boomslang bites. This treatment, in cases of severe boomslang envenomation, will not save the life of a dog. I would guess it is cases of mild envenomation. Exactly the same in humans - in cases of severe envenomation where antivenom is not available, people do die, no matter how much blood or platelets you supplement. And well documented in the literature. Anti-inflammatories make no sense and the major benefits of Vitamin K in snakebite were disproved more than 50 years ago. 2022/04/04, 13:37 - Riaan Mulder : I have never needed more than one ampule for boomslang. They respond very quickly. All the major hospitals in PE stock the antivenom, so I get from them as boomslang bites occur infrequently. We also seldom use more than 3 ampules polyvalent antivenom in puff adder bites. 2022/04/04, 13:46 - Raoul Strydom: One dog bitten 5 times, the other bitten 7 times by a large boomslang, in both cases multiple blood transfusions pulled them through. 2022/04/04, 14:10 - Douw Grobler: (Johan Marais) : We have no good evidence of regional differences in venom potency and little research has been done in this regard. The major problem is that one never knows how much venom is injected and bites differ vastly. Puff adders have around 300 mg of venom and around 50 mg is regarded as a lethal dosage for humans. So if bitten you may get no venom (dry bites are not unusual - and then Vitamin K seems very effective), 10 mg that will do little damage or over 200 mg and that will be messy. We have looked at Rinkhals venom throughout the range and the difference in potency was insignificant. 2022/04/04, 14:35 - Raoul Strydom: Vit K & blood transfusions advocated for boomslang bites, not going to make a significant difference for puff adder bites. 2022/04/04, 14:43 - Riaan Mulder : Puff adder bites cause massive tissue damage and consumes most clotting factors. It does make a big difference, especially if no antivenom is available 2022/04/04, 15:26 - Annie Mears: We use blood transfusions for severe puff adder bites like this dog. Her clotting times visibly increased over a few hours. By the time she was so swollen to need a tracheostomy tube she was unable to clot. She had two blood transfusions. Made a full recovery. We also used tranexamic acid. 2022/04/04, 15:39 - Erik Verryne: We see quite a number of puff adder bites, especially spring and autumn. We use iv fluids, polyvalent antivenom, cortisone, antibiotics and a small amount of adrenaline. If antivenom is not available, and it is relatively early, we mix DMSO 1ml/kg iv in a drip and administer it over 6-12 hours. The swelling is usually gone within 24 hours and we seldom see necrosis. 2022/04/04, 15:40 - Riaan Mulder: The worst necrosis I have seen was with night adder (not supposedly toxic?); also seldom see puff adder necrosis. 2022/04/04, 16:01 - Henry Labuschagne: Mildly venomous and cytotoxic. I have seen severe tissue necrosis in dogs bitten by Causus rhombeatus. 2022/04/04, 16:02 - Martin Malan: We have very few clients that will be prepared to pay for polyvalent antivenom so we never stock it and we see plenty of puff adder bites. Very few seem to need antivenom. So far only seen Dachshunds needing antivenom and if they need it they need it ASAP. Skin necrosis seems to be very rare, even if the tissue damage looks bad initially. I've always treated with corticosteroids only. Swelling usually down within 24h. I know of farmers that don't even bother bringing the dog in after a bite and then it's also fine, so I sometimes wonder how much we actually need to interfere. 2022/04/04, 16:11 - Andre Uys: (Moderator) : Successful snake bite treatment in three juvenile African wild dogs (Lycaon pictus) with polyvalent antivenom : a Namibian case report. Abstract: This article reports the first documented treatment of venomous snakebite with a polyvalent snake antivenom from the South African Institute for Medical Research in endangered African wild dogs (Lycaon pictus). Three juvenile male animals (6.5 months of age) showed clinical signs after being bitten by an unidentified venomous snake. The signs included loss of appetite, disorientation, impaired locomotion, excessive facial swelling, profuse salivation, reduced respiratory effort and an apparent depressed mental state. Intravenous treatment with isotonic Ringer lactate solution, hetastarch 6% and dexamethazone, subcutaneous administration of procaine benzylpenicillin and benzathine benzylpenicillin, and ultimately intravenous administration of the polyvalent snake antivenom resulted in the complete recovery of all three wild dogs. 2022/04/04, 16:42 - Rob Jackson: I once had a confirmed puff adder bite on the shoulder, with no swelling. I put it on a drip, kept overnight just in case, dead in the morning, haematocrit zero. Think venom went iv. I used to monitor haematocrit on puff adder bites but this stopped me being casual about it. 2022/04/04, 17:24 - Andre Uys: I think the dogs that get bitten direct into a muscle belly are at most risk. Larger dogs most likely get subcutaneous envenomation and seem to do as well from observation as treatment. Small breeds often show systemic signs and require antivenom.
