Padula Andrew M, Winkel Kenneth D
Australian Venom Research Unit, Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Melbourne, Parkville, Australia.
Australian Venom Research Unit, Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Melbourne, Parkville, Australia.
Toxicon. 2016 Apr;113:7-10. doi: 10.1016/j.toxicon.2016.01.065. Epub 2016 Feb 4.
A fatal outcome of a presumed tiger snake (Notechis scutatus) envenomation in a cat is described. Detectable venom components and antivenom concentrations in serum from clotted and centrifuged whole blood and urine were measured using a sensitive and specific ELISA. The cat presented in a paralysed state with a markedly elevated serum CK but with normal clotting times. The cat was treated with intravenous fluids and received two vials of equine whole IgG bivalent (tiger and brown snake) antivenom. Despite treatment the cat's condition did not improve and it died 36 h post-presentation. Serum concentration of detectable tiger snake venom components at initial presentation was 311 ng/mL and urine 832 ng/mL, this declined to non-detectable levels in serum 15-min after intravenous antivenom. Urine concentration of detectable tiger snake venom components declined to 22 ng/mL at post-mortem. Measurement of equine anti-tiger snake venom specific antibody demonstrated a concentration of 7.2 Units/mL in serum at post-mortem which had declined from an initial high of 13 Units/mL at 15-min post-antivenom. The ELISA data demonstrated the complete clearance of detectable venom components from serum with no recurrence in the post-mortem samples. Antivenom concentrations in serum at initial presentation were at least 100-fold higher than theoretically required to neutralise the circulating concentrations of venom. Despite the fatal outcome in this case it was concluded that this was unlikely that is was due to insufficient antivenom.
本文描述了一例猫被疑似虎蛇（盾鼻蛇属）咬伤后死亡的病例。使用灵敏且特异的酶联免疫吸附测定法（ELISA）检测了来自全血凝块、离心后的全血及尿液中的血清中可检测到的毒液成分和抗蛇毒血清浓度。这只猫呈现出瘫痪状态，血清肌酸激酶（CK）显著升高，但凝血时间正常。该猫接受了静脉补液治疗，并注射了两小瓶马全IgG双价（虎蛇和棕蛇）抗蛇毒血清。尽管进行了治疗，这只猫的状况并未改善，在就诊后36小时死亡。初次就诊时血清中可检测到的虎蛇毒液成分浓度为311 ng/mL，尿液中为832 ng/mL，静脉注射抗蛇毒血清15分钟后血清中该成分降至检测不到的水平。尸检时尿液中可检测到的虎蛇毒液成分浓度降至22 ng/mL。对马抗虎蛇毒特异性抗体的检测显示，尸检时血清中该抗体浓度为7.2单位/mL，已从注射抗蛇毒血清15分钟时最初的高水平13单位/mL下降。ELISA数据表明血清中可检测到的毒液成分已完全清除，尸检样本中未再次出现。初次就诊时血清中的抗蛇毒血清浓度比理论上中和循环毒液浓度所需的浓度至少高100倍。尽管该病例出现了致命结果，但得出的结论是，这不太可能是由于抗蛇毒血清不足所致。
