John Eckley wrote:I spoke to a friend, who is not a member here, and this is what he send me:
Report from prof Gouse Oberholzer is that those drugs have been used to treat cobra bites in indias for the past 15 years with mixed result! It is possible that the cases successfully treated may well have been mistaken identity and may well have been harmless or mildly venomous species!
John Eckley wrote:I spoke to a friend, who is not a member here, and this is what he send me:
Report from prof Gouse Oberholzer is that those drugs have been used to treat cobra bites in indias for the past 15 years with mixed result! It is possible that the cases successfully treated may well have been mistaken identity and may well have been harmless or mildly venomous species! The tests done on african cobra s and mambas produced negetive results and pollyvalent antivenom was eventualy resorted to to ensure the victims survival! A recent case was successfully treated where the victim had a low body mass and even though serious symptoms were recorded the patients blood oxygene percentagess sugest that the. Bite may have been a low venom yield. The result is therefore inconclusive!
Bushviper wrote:
By last night her symptoms suddenly got worse and her eyelids were drooping and she was getting weaker. This only started about 7 hours after the bite which is very unusual. I went through late last night and checked on her but I felt she did not look too bad.
Bushviper wrote:
We decided not to give her antivenom because she is still young and in her career she might need antivenom for a life threatening or serious cytotoxic bite. Being in an ICU we knew they could monitor her progress and act within minutes if required. I had supplied them with enough antivenom and they had it in a fridge in the unit in the event that things went downhill suddenly.
This afternoon our very own Jenna Taylor and Wolfgang Wuster got into a discussion about possibly using neostigmine which basically kick starts the nerves that have been affected. After a few minutes I decided that we should try this for the snouted bite despite it never having been done before that any of us are aware of. WW mailed me the previous research in this regard and I went off to hospital.
I then managed to convince the doctors to have a look at this option and try it. They agreed with me that it was worth a try and this evening we gave the lady a mixture prescribed by Jenna. Within a minute her eyes were open and two minutes later she was swallowing easily. She could focus and looked 100% normal.
I know it could wear off and top ups will be required but I am just glad that in this case it worked. That means that in future in rural areas where they dont have antivenom they can use neostigmine and glycopyrrolate to counter these effects even if it just helps to get the patient to where he can be ventilated.
I am tired from very little sleep and worrying all day riding up and down to check on her but now I am going to go have a beer!
Bushviper wrote:
Usually we see symptoms within 30 minutes although I have seen some within minutes of a serious bite.
Blet wrote:Bottom line is...loads of study possibilities still here. The reality is that, even though WE may find snake envenomations interesting and of importance, it remains of relatively minor importance in SA compared to most medical emergencies. The fact that you can ID the group/genus of snake involved in a bite and administer very specific treatment and antivenom from a small blood or urine sample in Australia, makes quite a big difference. We've got 2 antivenom options of wich Bommslang hardly ever gets administered. Studies around synthetic 'antivenom' as apposed to horse or sheep serum based products are also encouraging...but these newer options are extremely expensive. In the SA situation even local products are mighty expensive. From a veterinary perspective, I see mostly Cape Cobra bites and these average around R15000-20000 per simple case...and I've lost patients 4d after regaining the ability to breath spontaneously. Interestingly, the last study on Puffadder bites, suggest no antivenom treatment at all...that's likely to change due to new studies on coagulopathies and I must admit seeing more than a few acute deaths from confirmed Puffy bites within 90min of the actual event...this is in and around Cape Town and I do believe there is a variation in effect and virulence depending on dose, age/size of patient, age/size of snake and locality. I count myself lucky if I get the oppertunity to treat a Cape Cobra bite in a dog...most patients do not make it to the clinic! Cape cobras and Mambas will alway remain a gigantic issue...If I ever got into a Cape cobra bite situation, I would insist on antivenom the minute neorological signs creep in. These animals are not to be underestimated! A final point...almost all Cape cobra bites in dogs (if the patient survives!) cause local tissue necrosis. I manage these as opn wounds and they heal uneventfully over a matter of 2-3w, but I found this interesting in such an obviously neurotoxic species!
A very good point to make. Thanks for the explaination Jen.Importantly, neostigmine is not a replacement for antivenom. I foresee it rather as an option when there is no antivenom available or when a patient has had previous anaphylaxis with antivenom.
yoson10 wrote:Bushviper wrote:
Usually we see symptoms within 30 minutes although I have seen some within minutes of a serious bite.
Yeah that's what I have seen/read about in Asian cobras...They symptoms are usually very fast appearing..I have heard about people have their diaphragms paralyzed within 10 minutes.
Dendroaspis_bastian wrote:yoson10 wrote:Bushviper wrote:
Usually we see symptoms within 30 minutes although I have seen some within minutes of a serious bite.
Yeah that's what I have seen/read about in Asian cobras...They symptoms are usually very fast appearing..I have heard about people have their diaphragms paralyzed within 10 minutes.
Are you serious? Show me an actual case of this happening? It certainly isn't the case with Naja naja or Naja kaouthia - as their venoms are both of very high molecular weight, meaning for an elapid, the venom is slow to act. The case is seen across just about all asiatic cobras - - Naja sputatrix and Naja philippinensis carry high molecular weight venom proteins.
I think N. nivea has the lowest molecular weight venom proteins of any cobra, making its venom the most rapid-acting of any cobras.
Kraits and australian brown snakes, though more venomous than any cobra, also have very high molecular weight venoms (which is why death may be prolonged for hours, even days in the case of some krait species).
I can assure you that you will never ever be able to materialize a case where any asiatic cobra "paralyzing diaphragms in 10 minutes". That's just BS. As a holder of a degree in clinical laboratory science, I just laugh when I see that considering the fact that all the proteins (the lethal part of venoms) I've worked with from most alpha-neurotoxins (both long and short proteins) are of high molecular mass.
Dendroaspis_bastian wrote:Nothing you said contradicts what I said. First, the Philippine cobra is considered to be the most venomous of all the Naja species. You materialized 3 cases in which paralysis set in in 30 minutes (cases could've been IV or very close to blood vessels, or not) - not 10 minutes though. If he had claimed 30 minutes, I wouldn't have objected - but 10 minutes? Most often, it takes almost 20 minutes for symptoms to begin to manifest. That's one thing. Yoson10, keeps insisting that Naja naja is this extremely venomous snake that can kill people in 15 minutes, which is total BS. As I said in my first post on this board, which I believe was deleted. It was in the topic of "asiatic snakes vs african snakes" or something along those lines. I mentioned that it is the smaller, island bound cobra species that are the more venomous and often more dangerous - N. sputatrix, N. philippinensis, N. atra (it is island bound in Taiwan). The Indian cobra, monocled cobra, and even the king cobra (though not a true cobra) are in fact less venomous than the species I first mentioned.
I'm not contradicting Drs. Watt and his colleagues, I am telling yoson10 that paralysis will not set in in 10 minutes. Maybe its possible in a case of a severe black mamba envenomation, but not any Asiatic cobras. Dendrotoxins are the far more rapid-acting than alpha-neurotoxins, beta-neurotoxins, and cardiotoxins.
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