Animal Poisoning

Scorpion

Neurotoxin

Asetilkolinesterase, hialuronidase, serotonin, fosfolipase A2

Acts on neuronal synapse and neuro-muscular junction

Increased neuron sodium permeabilityNeurotransmitter release at synapses

Increased acetylcholine release at neuromuscular junction

(Centuroides sculpturatus)

Gejala : nyeri lokal, rasa terbakar

Sistemik : diplopia, nistagmus, hipereksitabilitas,opistotonus, hipersalivasi, takikardi, kejang

Dekontaminasi

Antidotum : serum scorpion (polivalen)

SnakeNeurotoxins: have the ability to damage and or destroy nerve tissues

Cobra & Coral snake

Haematoxins: affects the blood and causes Haemolysis and Hemorrhage

Vipers

slower and more painful than the neurotoxin

• Myotoxins: these cause muscle pain and turn urine brown to black because of the protein Myoglobin that is present

• Sea snake

• There are no symptoms really.

• Just severe upper body pain and urine changes to brown black color

Coral snake copperhead

Western Diamondback Rattlesnake

Sea Snake

Black Spitting Cobra

Ptosis in victim of Coral Snake bite

Bite from a Western Diamondback Rattlesnake

TINGKAT

KERACUNANGEJALA / TANDA

KLINIK

TERAPI

0. Tidak keracunan Abrasi, lobang gigitan,

nyeri, bengkak ringan

Perawatan luka lokal,

tidak perlu ABU

I. RINGAN Nyeri, bengkak, parestesi

perioral bisa muncul

Jika perlu ABU dapat

diberikan 5 vial

II. SEDANG Nyeri, bengkak, eritema,

gejala sistemik kadang

muncul, koagulopati ringan

ABU 5 – 15 vial

III.BERAT Nyeri berat, bengkak seluruh

ekstrimitas, gejala sistemik

berat, koagulopati

ABU minimal 15 –

20 vial

IV.MENGANCAM

HIDUP

Gejala dan tanda yang

sangat berat, koagulopati

berat

ABU minimal 25 vial

KERACUNAN SISTEMIK

Kelainan Hemostatik perdarahan spontan sistemik, koagulopati, trombositopeni

Neurotoksik ptosis, eksternal opthalmoplegi, paralysis

Kelainan Kardiovaskuler hipotensi, shock, aritmia, EKG abnormal

Gagal ginjal akut oliguri, anuri, peningkatan ureum, kreatinin

Hemoglobin/mioglobinuria urin warna coklat gelap, dipstick

Kelainan laboratorium 20 WBCT > 20 menit, peningkatan atau penurunan hematokrit

KERACUNAN LOKAL

Pembengkakan > ½ bagian tanpa torniket

Pembengkakan jari setelah digigit jari kaki atau tangan

Pembengkakan yang cepat dalam beberapa jam bengkak sudah sampai pergelangan tangan atau kaki sesuai

tempat gigitan

Pembengkakan limfonodi

Tindakan pada gigitan ular

menjauhkan dari tempat kejadianmenjaga agar tetap hangatmeletakkan bagian tubuh yang tergigit lebih rendah dari jantungimobilisasiPasien gigitan ular harus dikirim ke unit gawat darurat untuk :

pembersihan luka pemberian toksoid tetanus pemberian cairan intravena pemeriksaan laboratorium

(Jucket & Hancock ,2002)

Pertolongan pertama

transport ke rumah sakit

pemeriksaan klinik secara cepat dan resusitasi

pemeriksaan klinik teliti dan menyeluruh serta diagnosis jenis ular

pemeriksaan laboratorium

pemberian anti bisa ular (ABU)

observasi efek pemberian ABU dan penentuan perlu tidaknya pemberian ABU ulangan

terapi suportif, terapi untuk bagian yang tergigit

rehabilitasi

terapi komplikasi kronik(Jucket & Hancock ,2002)

Pemeriksaan laboratorium

pemeriksaan darah rutin

angka trombosit

prothrombin time (PT)

activated partial-thromboplastin time(APTT)

fibrinogen

fibrin degradation products (FDP)

elektrolit

blood urea nitrogen (BUN)

kreatinin serum

urinalisis

Test mudah:

Test 20 WBCT : teteskan beberapa mililiter darah penderita kedalam tabung dan dibiarkan 20 menit.

Jika dalam waktu 20 menit masih cair berarti terdapat hipofibrinogenemi akibat racun ular.

SABU (Serum Anti Bisa Ular) polivalen 1 ml berisi:1. 10-50 LD50 bisa Ankystrodon2. 25-50 LD50 bisa Bungarus3. 25-50 LD50 bisa Naya sputarix4. Fenol 0,25% v/v.

Teknik Pemberian:2 vial @ 5 ml dalam 500 ml NaCl 0,9 % atau Dextrose 5%, 40-80 tetes per menit. Maksimal 100 ml (20 vial).

Venom Extraction (Milking)

How to Make AntiveninMilk the snake (make sure it has venom in it)

Inoculate a horse and let it build up antibodies to the it, this neutralizes the venom

Collect your horse serum with antibodies against toxins

Make sure your batch of antivenin is injected into infected blood stream within an hour, if not, you could be to late

WARNING: Antivenin only blocks further damage, it can’t undo whats already been done

SIDE EFFECTS: Could cause an allergic reaction ( i.e. serum sickness from the horse proteins)

Medicinal Value of Snake Venom

In the olden days, rattlesnake venom was administered by mouth and lotions to humans with leprosy. It was thought that the toxin that made the snakes wounds heal when it shed would also help humans. This was unsuccessful.

In 1994, it was found that certain proteins found in Copperhead venom helped to inhibit cancer cells from metastasizing

Copperhead venom has also been found to contain anticoagulants that are able to dissolve blood clots that cause strokes and heart attacks.

Two drugs that have been made from snake venom are Aggrastat, given to heart attack victims, and Ancrod, being tested for stroke victims.

Black widow

Neurotoxic venom

More potent than pit viper venom

Binds to nerve-ending calcium channelsTriggers neurotransmitter release

Blocks neurotransmitter re-uptake

Inhibits normal nerve impulse transmission

Produces low serum calcium

TreatmentAntivenin indicated for:

Hypertensive reactions

Acute respiratory distress

Jellyfish

Stinging cells (nematocysts) in tentacles

Intense, burning pain

Red, hemorrhagic lesions

Nausea, vomiting

Fever, chills

Respiratory distress, wheezing, stridor

Hypotension, shock

Cardiovascular collapse

Venomous FishSting ray

Scorpionfish (Lion fish, Stonefish)

Sea UrchinsImmerse injured area in hot water

Use acetic acid to dissolve embedded spines

Larger spines may require surgical removal

Hymenoptera

Bees, wasps, hornets, yellowjackets, ants

ProblemsAllergic reactions

Anaphylaxis

Toxic venom effects (rare)

Local reactionSharp, burning pain

Itching

Edema

Extensive reactions may involve entire extremity

Stings to tongue/throat may cause loss of airway

Systemic reactionsImmediate

Mild: Diffuse itching, urticaria, swelling distant from sting site, flushingSevere: Laryngeal edema, severe bronchospasms, profound hypotension

Delayed1 to 48 hours after stingMay be life threatening

TreatmentImmediate

Remove stinger (scrape)Manage airwayOxygenSupport BP with fluidEpinephrineAntihistaminesSteroid