Neurotoxicity, anticoagulant activity and evidence of rhabdomyolysis in patients bitten by death adders (Acanthophis sp.) in Southern Papua New Guinea

Four cases of snake envenomation responsive to death adder antivenom

“…A third possibility is that response to antivenom is adder-species dependent. The majority of reported human cases of death adder envenomation are from Papua New Guinea 10,14 and venom of death adder species in Papua New Guinea may be significantly more sensitive to death adder antivenom than the venom of the common death adder found in Perth, Western Australia.…”

“…Improvement in humans has only been noted in cases in which antivenom was administered in addition to anticholinesterases. 14,23 Cases 1 and 4 were given neostigmine and atropine during treatment. Subjectively, improvement of clinical signs was noted in Case 1, however, the improvement was insufficient to enable discontinuation of ventilatory support and more antivenom was required.…”

“…However, when antivenom administration is delayed to 18 h or longer after envenomation, recovery may be delayed. 10,14 In this case series, only Case 2 had a rapid response to a single vial of in-date antivenom and this envenomation was due to the less lethal bardick snake. Case 3 had a prolonged recovery but only required one vial of expired antivenom.…”

“…The venom has been shown to have a weak anticoagulant action which may cause moderate increases in prothrombin and activated partial thromboplastin times. 4,13,14 In humans, there have been no reports of clinical coagulopathy occurring with death adder envenomation and normal wholeblood clotting times have been reported. 10,13 Some species of death adders, including the northern death adders and those in Papua New Guinea, have also been shown to have mild myotoxic activity, which may cause mild to moderate increases in serum CK; 12 however, there have been no reports of myoglobinuria.…”

“…10,13 Some species of death adders, including the northern death adders and those in Papua New Guinea, have also been shown to have mild myotoxic activity, which may cause mild to moderate increases in serum CK; 12 however, there have been no reports of myoglobinuria. 10,14 Analysis of death adder venom from different species and to a lesser degree within geographic variants of the common death adder (Acanthophis antarticus) species, reveals variations in venom composition and neurotoxic activity as well as in susceptibility to neutralisation by antivenom. 15,16 Death adder antivenom was effective at preventing the neurotoxic effects of all species of death adder, however higher concentrations were required for venom from A antarcticus compared to venom from A pyrrhus (desert death adder) and A praelongus (northern death adder).…”