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The clinical evolution and management of a 22-yr-old male envenomed by a captive female inland taipan, Oxyuranus microlepidotus (McCoy, 1879), Elapidae, at a public educational reptile exhibit (Florida, USA) is reported. The patient was bitten (quick 'bite and release') in the right hand between digits #3 and 4 while performing captive maintenance. The victim did not attempt any first aid, but urgently presented to the local hospital within 25 mins post-bite. The patient had an unremarkable medical/surgical history including no previous envenoming/treatment with antivenom. Within approximately 5 mins post-bite he reported experiencing transient loss of consciousness/syncope, altered sensorium, nausea, dull headache, weakness, and "severe" bite site pain. Laboratory investigations revealed profound defibrinating coagulopathy including thrombocytopenia; there was only mildly elevated creatine kinase and renal function remained within normal limits. The patient's clinical evolution included cranial nerve palsies manifested as dysconjugate gaze, persistent, but minor, bite site bleeding, asthenia and reported myalgia as well as prolonged intense bite site pain. He was successfully and uneventfully treated with four vials of Australian polyvalent antivenom and one vial of taipan monovalent; all were expired products with expiration dates ranging from one month to 38 years. Effective antivenom therapy might have been achieved with only 2, possibly 3 vials; however, concerns about reduced efficacy of the long-expired antivenom (4/5 vials were expired 18–38 years) and persistent bite site bleeding/pain contributed to the provision of the additional vials. The patient recovered sufficiently for discharge in 48 h; there were no sequelae. There have been approximately 12 formally documented cases of O. microlepidotus envenoming and selected, detailed examples of these are briefly considered and compared with the clinical evolution of our patient; patient-centred recommendations for management of Oxyuranus spp. envenoming are discussed. The need for advanced preparedness and an action plan for any institution/collection that contains non-native, medically significant venomous species is emphasised, and a general recommended approach is outlined. • 22-yr-old male envenomed by captive Inland Taipan, Oxyuranus microlepidotus. • Transient loss of consciousness, profound defibrinating coagulopathy, cranial nerve palsies.• Effective treatment with long-expired, specific antivenoms.• Review of formally documented O. microlepidotus envenoming and management of Oxyuranus envenoming. [Display omitted] • Documentation of a life-threatening envenoming by a captive Inland Taipan, Oxyuranus microlepidotus , in Florida, USA. • Clinical evolution included loss of consciousness, defibrinating coagulopathy, cranial nerve palsies. • Patient effectively and uneventfully treated with long-expired, specific antivenoms. • Review of the handful of documented O. microlepidotus envenoming. • Recommendations for management of Oxyuranus envenoming and preparedness for collections holding non-native species. [ABSTRACT FROM AUTHOR]

Fab antivenom (FabAV) halts progression of tissue injury and improves recovery in copperhead snakebite. It is unknown if F(ab')2AV does as well. The objective of this study was to compare control of tissue injury in copperhead snakebite patients treated with F(ab')2AV versus FabAV. We performed a post hoc analysis of copperhead envenomated patients in a clinical trial comparing F(ab')2AV to FabAV. The outcomes for this analysis are the number of repeat doses required to obtain initial control, the number of patients requiring unscheduled doses during maintenance, and the time from antivenom administration to initial control. Twenty-one (13 F(ab')2AV, 8 FabAV) were copperhead patients. Median age was 46 years with a male predominance. Baseline severity was similar. One (8%) F(ab')2AV and 2(25%) FabAV patients required repeat initial dosing, difference = 17%, (95%CI −18, 57%). One (8%) F(ab')2AV and 1(13%) FabAV patients required additional doses after maintenance, difference = 5%, (95%CI −27, 45%). Median time to initial control was 2.7 range (2.0, 9.3) hours and 3.5 range (2.0, 7.4) for F(ab')2AV and FabAV respectively, difference −0.8 h (95% CI −2.6, 0.9). This exploratory analysis suggests that the available measures of the control of venom-induced tissue injury are similar between antivenom subgroups. [ABSTRACT FROM AUTHOR]

The article focuses on a case study of a potential envenomation attributed to a bite by a Western Fence Lizard. Topics include the nature of the symptoms, alternative explanations for the effects, and the need for comprehensive clinical documentation in similar cases to determine medical significance.

Abstract: Aluminium phosphide (AlP) is a toxic agent associated with a high mortality rate following acute exposure from various routes. The aim of this study was to determine the clinical and laboratory findings useful for predicting the medical outcome of AlP‐poisoned patients using established scoring systems. This is a prospective study of AlP‐poisoned patients from 2010 to 2015 in Ardabil, Iran. All patients that presented with a confirmed diagnosis of acute AlP poisoning in the study interval were included in the study. Clinical and laboratory data, using Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score II (SAPS II) scoring systems, were compared for their predictive value in determining differences between survived and non‐survived patients. Univariate analysis (Mann–Whitney or t‐test), multiple logistic regression analysis, receiver operating characteristic (ROC) curve analysis and the Pearson correlation test were performed using STATA/SE 13.0 and the Nomolog Software. A total of 68 AlP‐poisoned patients with confirmed acute AlP poisoning were included for evaluation. Of these, 36 were non‐survived. Multiple logistic regression analysis was performed using parameters and values derived from patient clinical and laboratory data, and revealed that four factors were significant for predicting mortality: Glasgow coma score (GCS); systolic blood pressure (SBP); urinary output (UOP); and serum HCO3. A four‐variable, risk‐prediction nomogram was developed for identifying high‐risk patients and predicting the risk of mortality. Study results showed that SBP of <92.5 mmHg (p = 0.006); HCO3‐ < 12.9 mEq/L (p = 0.01), UOP < 1725 mL/day (p = 0.04); and GCS < 14.5 (p = 0.003) were significant predictors of AlP mortality. Scoring systems analysis showed SAPS II score >24.5, APACHE II score >8.5 and SOFA score >7.5 were predictive of non‐survival patients. The results of our study showed that SBP, GCS, UOP and serum HCO3 levels are the best prognostic factors for predicting mortality in AlP‐poisoned patients. According to the area under the ROC curve of the APACHE II score, when compared with SOFA and SAPS II scores, the APACHE II score can more effectively discriminate between non‐survivors and survived patients. [ABSTRACT FROM AUTHOR]

The article discusses research on the specie, "Crotalus Pyrrhus (Southwestern Speckled Rattlesnake)" and explores about its geographical distribution and collection of specimen, along with explores diet of the species.

Introduction:Protobothrops mangshanensis, the Mangshan pit viper, is a rare pit viper native to the area surrounding Mount Mang in China’s Hunan province. Toxicity from envenomation is not well characterized.Case details: A 33-year-old male presented to an emergency department (ED) after being bitten on the forearm by hisP. mangshanensis. He complained of mild swelling and pain at the bite site. He was admitted for observation and toxicology consultation. Following initially normal coagulation studies including platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and D-dimer, fibrinogen decreased to 121 mg/dL and D-dimer concurrently rose to 377 ng/mL over 24 h. On hospital day 2 fibrinogen stabilized at 109 mg/dL and he was discharged with outpatient laboratory monitoring. Three days later, he returned with bruising to the contralateral arm. Fibrinogen was undetectable (<40 mg/dL) and PT was 14.6 s. He declined admission but returned 2 d later with bruising to the nose. Bloodwork revealed immeasurably prolonged PT, aPTT, and thrombin time, but he eloped. Late that evening he returned and was treated with three vials of Green pit viper (Trimeresurus albolabris) antivenom. Within 24 h coagulopathy improved markedly; at five days, coagulation abnormalities resolved.Discussion: Mangshan pit viper envenomations may cause isolated hemotoxicity, despite molecular studies suggesting additional neurotoxicity and myotoxicity.T. albolabrisantivenom appears effective in treating the resultant coagulopathy.Conclusion: We report the natural history of envenomation by the Mangshan pit viper. A delayed coagulopathy, apparently fibrinolytic in nature, is unaccompanied by local tissue destruction and responsive to Green pit viper antivenom. [ABSTRACT FROM AUTHOR]

We have previously shown that acetaldehyde, a constituent of tobacco smoke, increases nicotine self-administration in adolescent, but not adult, rats. The aim of this study was to determine whether acetaldehyde influences other behavioral, endocrine, or neuronal responses to nicotine at either age. Juvenile (postnatal day (P) 27) and adult (P90) male Sprague–Dawley rats were treated with saline, acetaldehyde (16 μg/kg/injection × 2, i.v.), nicotine (30 μg/kg/injection × 2, i.v.) or a combination of acetaldehyde and nicotine. Locomotion and center time were evaluated for 30 min in a novel open field, before measurement of plasma corticosterone levels and brain c-fos mRNA. Nicotine increased locomotor activity in juveniles but decreased it in adults; in contrast, center time was increased at both ages. Acetaldehyde potentiated nicotine's locomotor effects, but not center time. Nicotine induced c-fos expression in the bed nucleus of the stria terminalis, the central nucleus of the amygdala (CeA), nucleus accumbens, and the superior colliculus (SC) at both ages, whereas it activated the hypothalamic paraventricular nucleus (PVN) and consequent corticosterone secretion only in adults. Acetaldehyde potentiated nicotine-induced c-fos in CeA and SC, and activation of PVN c-fos expression/plasma corticosterone release; however, this drug interaction was only observed in behaviorally tested animals, not those that were minimally stressed. Thus, acetaldehyde may modulate the interaction of nicotine and stress. Although pharmacokinetic studies showed that acetaldehyde did not change nicotine levels in either brain or serum, nicotine penetration into the brain was slower in juveniles as compared to adults.Neuropsychopharmacology (2007) 32, 2025–2035; doi:10.1038/sj.npp.1301327; published online 7 February 2007 [ABSTRACT FROM AUTHOR]

A sensitive and reliable HPLC method that allows simultaneous quantification of phytoestrogens extracted from kudzu-root and soy preparations, and serum samples has been developed. Kudzu-root and soy preparations were mixed with 5 µg flavone and 15 µg rutin (internal standards) and the phytoestrogens were extracted by using solid-phase (C18) extraction cartridges. Blank or spiked serum samples were extracted by using either C18 cartridges or trichloroacetic acid-methanol extraction. The extracts were analyzed by the HPLC equipped with a reverse-phase (250 × 4 mm, C18) column and UV, diode-array or MS detector. A linear gradient of acetic acid and acetonitrile provided excellent separation of glycoside and aglycone-phytoestrogens from kudzu root and soy preparations. The C18 cartridge extraction of serum yielded excellent recovery of both glycoside- and aglycone-phytoestrogens, while the trichloroacetic acid-methanol extraction yielded excellent recovery of glycoside but poor recovery of aglycone compounds. UV and MS detectors were suitable for phytoestrogen analysis in plant and serum samples, while the diode-array detector was suitable for generating the UV absorbance curve for phytoestrogens. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Presents a study which investigated quality in ephedrine-containing dietary supplements. Experimental section; Results and discussion; Conclusion.

Addresses the potential role of calcium channel blockade in tricyclic antidepressant-induced hypotension. Inhibition of calcium influx by calcium channel blocking drugs such as verapamil or nifedipine which can contribute to the hypotension; Potential importance of calcium channel blocker as a contributor to tricyclic antidepressant (TCA) toxicity.

Rapid Administration of High-Dose Human Antibody Fab Fragments to Dogs: Pharmacokinetics and Toxicity. Keyler, D. E., Salerno, D. M., Murakami, M. M., Ruth, G., and Pentel, P. R. (1991). Fundam. Appl Toxicol 17, 83-91. The treatment of drug overdose with drug-specific antibody fragments may require very high antibody doses. To address the feasibility of this therapy, we studied the pharmacokinetics and toxicity of high-dose human nonspecific Fab fragments in beagles. Three dogs received 5.3 g/kg Fab iv over 1 hr. Because nephrotoxicity was observed, three subsequent dogs received 3.2 g/kg. The fraction of the Fab dose excreted in urine (10 ± 6%%) was lower than reported values for either high or low doses of Fab in other species. The terminal serum elimination half-life (42 hr for the higher and 48 hr for the lower dose) was also longer than reported values for other species, due to lower renal and nonrenal Fab clearance. Fab administration was tolerated without adverse hemodynamic effects. One of three dogs at each dose developed transient oliguria. All dogs developed a transient but marked increase in the serum creatinine concentration. At 2 weeks creatinine clearance had returned to normal. Urinary protein and albumin excretion at 2 weeks were within the normal range for dogs but were increased over their baseline values. The histology of all organs was normal at 3 weeks by light microscopy, and renal histology by electron microscopy was also normal. The mechanism of Fab nephrotoxicity, not observed previously with high-dose Fab in rats or lower doses of Fab in other species including dogs, is not clear. These data suggest that further study of the potential toxicity of high-dose Fab, and its reversibility, is needed to assess the feasibility of treating drug overdose with this antibody fragment The long terminal half-life of high-dose Fab in the dog and its low renal clearance contrast with values observed with lower doses of Fab in other species but would not be expected to preclude the use of high-dose Fab for drug overdose. [ABSTRACT FROM PUBLISHER]

The clinical evolution and management of a 22-yr-old male envenomed by a captive female inland taipan, Oxyuranus microlepidotus (McCoy, 1879), Elapidae, at a public educational reptile exhibit (Florida, USA) is reported. The patient was bitten (quick 'bite and release') in the right hand between digits #3 and 4 while performing captive maintenance. The victim did not attempt any first aid, but urgently presented to the local hospital within 25 mins post-bite. The patient had an unremarkable medical/surgical history including no previous envenoming/treatment with antivenom. Within approximately 5 mins post-bite he reported experiencing transient loss of consciousness/syncope, altered sensorium, nausea, dull headache, weakness, and "severe" bite site pain. Laboratory investigations revealed profound defibrinating coagulopathy including thrombocytopenia; there was only mildly elevated creatine kinase and renal function remained within normal limits. The patient's clinical evolution included cranial nerve palsies manifested as dysconjugate gaze, persistent, but minor, bite site bleeding, asthenia and reported myalgia as well as prolonged intense bite site pain. He was successfully and uneventfully treated with four vials of Australian polyvalent antivenom and one vial of taipan monovalent; all were expired products with expiration dates ranging from one month to 38 years. Effective antivenom therapy might have been achieved with only 2, possibly 3 vials; however, concerns about reduced efficacy of the long-expired antivenom (4/5 vials were expired 18-38 years) and persistent bite site bleeding/pain contributed to the provision of the additional vials. The patient recovered sufficiently for discharge in 48 h; there were no sequelae. There have been approximately 12 formally documented cases of O. microlepidotus envenoming and selected, detailed examples of these are briefly considered and compared with the clinical evolution of our patient; patient-centred recommendations for management of Oxyuranus spp. envenoming are discussed. The need for advanced preparedness and an action plan for any institution/collection that contains non-native, medically significant venomous species is emphasised, and a general recommended approach is outlined., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Fab antivenom (FabAV) halts progression of tissue injury and improves recovery in copperhead snakebite. It is unknown if F(ab') 2 AV does as well. The objective of this study was to compare control of tissue injury in copperhead snakebite patients treated with F(ab') 2 AV versus FabAV., Methods: We performed a post hoc analysis of copperhead envenomated patients in a clinical trial comparing F(ab') 2 AV to FabAV. The outcomes for this analysis are the number of repeat doses required to obtain initial control, the number of patients requiring unscheduled doses during maintenance, and the time from antivenom administration to initial control., Results: Twenty-one (13 F(ab') 2 AV, 8 FabAV) were copperhead patients. Median age was 46 years with a male predominance. Baseline severity was similar. One (8%) F(ab') 2 AV and 2(25%) FabAV patients required repeat initial dosing, difference = 17%, (95%CI -18, 57%). One (8%) F(ab') 2 AV and 1(13%) FabAV patients required additional doses after maintenance, difference = 5%, (95%CI -27, 45%). Median time to initial control was 2.7 range (2.0, 9.3) hours and 3.5 range (2.0, 7.4) for F(ab') 2 AV and FabAV respectively, difference -0.8 h (95% CI -2.6, 0.9)., Conclusions: This exploratory analysis suggests that the available measures of the control of venom-induced tissue injury are similar between antivenom subgroups.