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Diagnosis and Treatment of Snake Envenomation in Dogs in Queensland, Australia.

ABSTRACT: Australia has some of the most venous snakes in the world, and envenomations of domestic dogs are common, but clinical signs as well as the diagnostic procedures and treatments of snake envenomations are poorly described. Therefore, we invited veterinary clinics in the state of Queensland, Australia, to provide detailed data on snake envenomation cases in dogs. A total of 230 cases were reported from 19 veterinary hospitals, with an average of 12.1 dogs per clinic, per year. Detailed case data were provided from 20 dogs-of these, 65.0% (13/20) were envenomated during the daytime, with collapse and paresis being the most common signs reported by owners. The median time between the onset of clinical signs and admission to the veterinary hospital was 60 min. Clinical signs were the sole diagnostic modality utilised by veterinarians in 30.0% (6/20) of cases. Activated clotting time was the most common diagnostic procedure conducted, while snake venom detection kits (SVDK) were only used in 15.0% (3/20) of cases. Of the dogs that received antivenom (85.0%, 17/20), the tiger/multibrown combination (3000 units tiger/4000 units brown) was predominately (13/17) provided. Three of the 17 dogs that received antivenom (17.6%) died or were euthanised. About 82.4% (14/17) of the dogs treated with antivenom, but only 33.3% (1/3) of the dogs not treated with antivenom, recovered (p = 0.140). Overall, veterinarians relied frequently on medical history, clinical signs, and diagnostic tests other than the SVDK and, thus, most likely, administered snake envenomation treatment based on their clinical experience.

SUBMITTER: Valenza L

PROVIDER: S-EPMC7909414 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Diagnosis and Treatment of Snake Envenomation in Dogs in Queensland, Australia.

Valenza Ludovica L Allavena Rachel R Haworth Mark M Cochrane Jonathon J Henning Joerg J

Veterinary sciences 20210120 2

Australia has some of the most venous snakes in the world, and envenomations of domestic dogs are common, but clinical signs as well as the diagnostic procedures and treatments of snake envenomations are poorly described. Therefore, we invited veterinary clinics in the state of Queensland, Australia, to provide detailed data on snake envenomation cases in dogs. A total of 230 cases were reported from 19 veterinary hospitals, with an average of 12.1 dogs per clinic, per year. Detailed case data w ...[more]

PMID: 33498447

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Project description:BackgroundMyotoxicity is one of the common clinical manifestations of red-bellied black snake (Pseudechis porphyriacus) envenomation characterised by elevated creatine kinase (CK) concentrations of greater than 1000 U/L. This study aimed to investigate the occurrence of myotoxicity in patients following envenomation.Methods/principal findingsPatient characteristics and serial blood samples (timed venom concentrations and CK concentrations, pre- and post- antivenom) from 114 patients (median age 41, 2-90y; 80 male) were extracted from the Australian Snakebite Project database. Patients were categorised into three groups based on peak CK concentrations [no myotoxicity (<1000 U/L), mild (1000-10,000 U/L) and severe (>10,000 U/L)]. The odds of (mild or severe) myotoxicity was lower in patients that received early antivenom (within 6 hours post-bite) compared to those that received late or no antivenom (odd ratio was 0.186; 95% confidence interval, 0.052-0.664). A population pharmacokinetic-pharmacodynamic (PKPD) model was developed to describe the relationship between the time course of venom (a mixture of toxins) and effect (elevated CK). In addition, a kinetic-pharmacodynamic (KPD) model was developed to describe the relationship between time course of a theoretical toxin and effect. Model development and parameter estimation was performed using NONMEM v7.3. No single set of parameter values from either the PKPD or KPD models were found that could accurately describe the time course of different levels of severity of myotoxicity. The predicted theoretical toxin half-life from the KPD model was 11 ± 3.9 hours compared to the half-life of venom of 5.3 ± 0.36 hours. This indicates that the putative causative toxin's concentration-time profile does not parallel that of venom.ConclusionEarly antivenom administration reduces the incidence of myotoxicity. The venom concentration profile does not appear to be the driver for myotoxicity following envenomation. Additional factors that affect the sensitivity of the patient to snake venom/toxins must be explored to understand the relationship with myotoxicity.

Project description:BackgroundAlthough much is known about signs, symptoms, and management in the acute phase of crotaline snake envenomation, little is known about signs, symptoms, function, and quality of life during the recovery phase. The purpose of this observational pilot investigation is to evaluate the utility of several clinical outcome instruments in the setting of copperhead snakebite, and to characterize the clinical course of recovery.MethodsThis is a multi-center prospective, open-label, observational study of patients envenomated by copperhead snakes. We administered the Disabilities of the Arm, Shoulder, and Hand (DASH), Lower Extremity Functional Scale (LEFS), Patient-Specific Functional Scale (PSFS), Work Productivity and Ability Impairment: Special Health Problem (WPAI: SHP), Patients' Global Impression of Change (PGIC), Patient's Global Assessment of Recovery (PGAR), and SF-36 instruments, obtained numeric pain rating scales, and measured grip strength, walking speed, and swelling prior to hospital discharge and 3, 7, 14, 21, and 28 days after envenomation.Results20 subjects were enrolled; none were lost to follow-up. Most (80%) had moderate severity swelling, and most (75%) received antivenom. Across the broad range of measures, abnormalities of pain, swelling, impairments of physical and role function, and quality of life persisted for 7-14 days in most subjects. Validated self-reported outcome measures, such as the DASH, LEFS, PSFS, PGIC, SF-36, and the daily activities impairment portion of the WPAI: SHP were more responsive than measurements of swelling or walking speed. Data quality issues limited the utility of the work impairment portion of the WPAI: SHP. Residual signs, symptoms, and impairment in some subjects lasted through the 28-day study period. The study design precluded any assessment of the effectiveness of antivenom.ConclusionsSigns, symptoms, impaired function, and decreased quality of life typically last 7 - 14 days after copperhead envenomation. Several tools appear responsive and useful in studying recovery from pit viper envenomation.Trial registrationClinicalTrials.gov NCT01651299.

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Diagnosis and Treatment of Snake Envenomation in Dogs in Queensland, Australia.

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Diagnosis and Treatment of Snake Envenomation in Dogs in Queensland, Australia.

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