Padula A M, Leister E M
Australian Venom Research Unit, Department of Pharmacology and Therapeutics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 3010, Australia.
Veterinary Specialist Services and Animal Emergency Service, Underwood, Queensland, 4119, Australia.
Toxicon. 2017 Nov;138:159-164. doi: 10.1016/j.toxicon.2017.09.001. Epub 2017 Sep 4.
Snakebite in dogs from Pseudechis porphyriacus (red-bellied black snake; RBBS) is a common envenomation treated by veterinarians in Australia where this snake occurs. This case report describes the successful treatment of a clinically severe RBBS envenomation in a dog with an experimental bivalent equine whole IgG antivenom and mechanical ventilation, following its presentation in a cyanotic state. The cause of the cyanosis and respiratory distress was considered due to paralysis from neurotoxins in RBBS venom. The dog was treated with two vials of bivalent antivenom, each containing sufficient antivenom to neutralise the lethal effects of 40 mg of tiger snake (Notechis sp) and 40 mg of brown snake (Pseudonaja sp) venom. Hypoxaemia (Sp0 of 75%) and hypercapnia (PaCO of 61 mmHg) indicated the need for mechanical ventilation (MV) to prevent imminent death. The dog was anaesthetised using total intravenous anaesthesia and MV used for 18 h. Following discontinuation of MV, it resumed spontaneous breathing thereafter and made a complete recovery. Serum biochemistry revealed a significant myopathy with elevated CK and AST levels, peaking approximately 48 h post-treatment. Elevated liver enzymes, suggestive of hypoxic liver injury, were detected during the period of hospitalisation. The dog represented approximately one week after hospital discharge because of inappetence and mild hepatopathy, which resolved spontaneously by 30 d post-treatment. A mild coagulopathy was initially present which resolved within 24 h following antivenom treatment. At initial presentation, RBBS venom antigen was detected by sandwich ELISA in urine and serum. Free RBBS venom antigen was not detected post-antivenom treatment. Human cases of RBBS requiring ventilatory support are rare. This unusual case of RBBS envenomation in a dog highlights its potential clinical severity in dogs, and the need for early, aggressive, MV to achieve a successful outcome in cyanosed and clinically severe cases.
在澳大利亚有红腹黑蛇（Pseudechis porphyriacus，简称RBBS）出没的地区，犬类被这种蛇咬伤导致中毒是兽医常处理的情况。本病例报告描述了一只犬被RBBS严重咬伤中毒后，在出现发绀状态时，使用实验性双价马全IgG抗蛇毒血清并结合机械通气成功治愈的过程。发绀和呼吸窘迫的原因被认为是RBBS毒液中的神经毒素导致的麻痹。这只犬接受了两小瓶双价抗蛇毒血清治疗，每瓶含有足够中和40毫克虎蛇（Notechis sp）和40毫克棕蛇（Pseudonaja sp）毒液致死效应的抗蛇毒血清。低氧血症（SpO₂为75%）和高碳酸血症（PaCO₂为61 mmHg）表明需要机械通气（MV）以防止即将发生的死亡。这只犬采用全静脉麻醉，机械通气持续了18小时。停止机械通气后，它恢复了自主呼吸并完全康复。血清生化检查显示有明显的肌病，肌酸激酶（CK）和天冬氨酸转氨酶（AST）水平升高，在治疗后约48小时达到峰值。住院期间检测到肝酶升高，提示存在缺氧性肝损伤。这只犬在出院后约一周因食欲不振和轻度肝病再次就诊，这些症状在治疗后30天内自行缓解。最初存在轻度凝血功能障碍，在抗蛇毒血清治疗后24小时内得到缓解。初次就诊时，通过夹心ELISA在尿液和血清中检测到RBBS毒液抗原。抗蛇毒血清治疗后未检测到游离的RBBS毒液抗原。人类RBBS病例需要通气支持的情况很少见。这例犬类RBBS中毒的特殊病例凸显了其在犬类中潜在的临床严重性，以及对于发绀和临床症状严重的病例，需要早期积极进行机械通气以取得成功治疗效果。
