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Sample records for antivenins

  1. Anaphylaxis with Latrodectus antivenin resulting in cardiac arrest.

    Science.gov (United States)

    Murphy, Christine M; Hong, Jeannie J; Beuhler, Michael C

    2011-12-01

    Latrodectus mactans antivenin is a safe and effective therapy for severe black widow spider envenomations when given to most patients. We report a case of a 37-year-old male with a history of asthma that was given L. mactans antivenin for symptoms related to a black widow envenomation and developed a severe anaphylactic reaction resulting in cardiac arrest. When traditional therapies failed, the patient was given methylene blue for anaphylactic shock resulting in a 30-h period of hemodynamic stability. Despite initial resuscitation, the patient ultimately died 40 h after presentation. Under the right circumstances, L. mactans antivenin remains a safe and effective therapy for severe black widow envenomations. However, anaphylaxis is a risk for those receiving this therapy, even when the antivenin is diluted and given as an infusion. We report the first death related to diluted L. mactans antivenin given as an infusion.

  2. Anaphylaxis with Latrodectus Antivenin Resulting in Cardiac Arrest

    OpenAIRE

    Murphy, Christine M.; Hong, Jeannie J.; Beuhler, Michael C.

    2011-01-01

    Latrodectus mactans antivenin is a safe and effective therapy for severe black widow spider envenomations when given to most patients. We report a case of a 37-year-old male with a history of asthma that was given L. mactans antivenin for symptoms related to a black widow envenomation and developed a severe anaphylactic reaction resulting in cardiac arrest. When traditional therapies failed, the patient was given methylene blue for anaphylactic shock resulting in a 30-h period of hemodynamic ...

  3. Anaphylaxis to scorpion antivenin and its management following envenomation by Indian red scorpion, Mesobuthus tamulus

    OpenAIRE

    Rahul Ramesh Bhoite; Girija Ramesh Bhoite; Dayanand N Bagdure; Himmatrao S Bawaskar

    2015-01-01

    Mesobuthus tamulus is an Indian red scorpion that is responsible for numerous cases of scorpion stings in the Indian subcontinent. Antivenin, vasodilators, and benzodiazepines are medications of choice in the treatment of scorpion bites. Adverse reactions such as anaphylaxis to antivenin have been infrequently described in the literature. We, herein, present a case of a 42-year-old man stung by Indian red scorpion while gardening at home in India, who presented with extreme pain at the sting ...

  4. An evaluation of snake bites and antivenin use at a regional medical center.

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    Watson, Larry I; Spivey, Christy; Menon, Cen Rema; Kotwall, Cyrus A; Clancy, Thomas V; Hope, William W

    2010-07-01

    Snake bites are a rare but challenging problem for surgeons. The purpose of our study was to evaluate our experience with snake bites at a regional medical center. We reviewed patients treated for snake bites from 2004 to July 2008. Demographics, clinical information, and outcomes were documented. Descriptive statistics were used, and chi2, t test, and Fisher exact test were used to compare patients based on antivenin use. A P value < 0.05 was considered significant. Over the study period, 126 patients presented to the emergency department with 44 (35%) requiring hospital admission. The average age was 38 years (range, 2 to 76 years); 66 per cent were male and 95 per cent white. Bites most commonly occurred in the summer and fall months with none from December through March. Copperhead bites accounted for 50 per cent of bites. An average of 4.8 vials of antivenin was given to 61 per cent of admitted patients with 93 per cent receiving the drug within 6 hours. Minor reactions to antivenin occurred in three patients (11%). Two patients required surgery (5%), and the readmission rate was 7 per cent. There was no known morbidity or mortality. When comparing patients who received antivenin with patients who did not, the only significant clinical variables were an increased prothrombin time (12.1 vs. 11.7, respectively; P = 0.048) and a longer length of hospital stay (3 vs. 1.8 days, P = 0.0006) in patients receiving antivenin. The majority of patients with snake bites can be treated with supportive care and antivenin when indicated. Antivenin use at our institution is largely based on physical findings and not related to laboratory values.

  5. The treatment of black widow spider envenomation with antivenin latrodectus mactans: a case series.

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    Offerman, Steven R; Daubert, G Patrick; Clark, Richard F

    2011-01-01

    Black widow spiders (Latrodectus mactans) are found throughout the US. Though bites are relatively uncommon, they pose a significant health problem with over 2500 reported to American poison control centers annually. Black widow spider bites cause a characteristic envenomation syndrome consisting of severe pain, muscle cramping, abdominal pain, and back pain. The significant pain associated with envenomation is often refractory to traditional analgesics. Antivenom (Antivenin Latrodectus mactans) is available and effective, but is often withheld because of a fear of acute hypersensitivity reactions. We report four cases of symptomatic black widow spider envenomation. One of the reported cases was managed without antivenom, and, in contrast, three were treated successfully with Antivenin Latrodectus mactans. We believe that these cases demonstrate safe and effective use of black widow antivenom. This article presents the rationale for use of antivenom in these cases, and a nonsystematic review of the pertinent literature.

  6. The Treatment of Black Widow Spider Envenomation with Antivenin Latrodectus Mactans: A Case Series

    OpenAIRE

    Steven R. Offerman; Daubert, G. Patrick; Clark, Richard F.

    2011-01-01

    Black widow spiders (Latrodectus mactans) are found throughout the US. Though bites are relatively uncommon, they pose a significant health problem with over 2500 reported to American poison control centers annually. Black widow spider bites cause a characteristic envenomation syndrome consisting of severe pain, muscle cramping, abdominal pain, and back pain. The significant pain associated with envenomation is often refractory to traditional analgesics. Antivenom (Antivenin Latrodectus macta...

  7. Kenyan medicinal plants used as antivenin: a comparison of plant usage

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    Kisangau Daniel P

    2006-02-01

    Full Text Available Abstract The success of snake bite healers is vaguely understood in Kenya, partly due to their unknown materia medica and occult-mystical nature of their practice. A comparison is made of plants used in snake bite treatments by two culturally distinct African groups (the Kamba and Luo. Thirty two plants used for snakebite treatment are documented. The majority of the antidotes are prepared from freshly collected plant material – frequently leaves. Though knowledge of snake bite conditions etiological perceptions of the ethnic groups is similar, field ethnobotanical data suggests that plant species used by the two ethnic groups are independently derived. Antivenin medicinal plants effectively illustrate the cultural context of medicine. Randomness or the use of a variety of species in different families appears to be a feature of traditional snake bite treatments. A high degree of informant consensus for the species was observed. The study indicates rural Kenya inhabitants rely on medicinal plants for healthcare.

  8. Snake antivenins crisis intervention therapy%抗蛇毒血清危机干预研究

    Institute of Scientific and Technical Information of China (English)

    王永高; 毛建芬; 谢碧玉; 芮君; 黄永祥; 曹朝梁; 吴立群; 章赛军

    2012-01-01

    目的 探讨毒蛇咬伤抗蛇毒血清危机干预疗法的临床疗效.方法 2010年8月~2011年12月为前瞻性观察期,台州市中心医院急诊科实施血清危机干预治疗76例(干预组);2007年11月~2010年8月为历史对照期,实施蛇伤程序化救治139例(血清组),比较两组间的蛇伤种类、临床分型、住院天数、致残率、死亡率、好转率等.计数资料以率表示,采用χ2检验,计量资料以(x - ±s)表示,采用t 检验,以P<0.05为差异具有统计学意义.结果 干预组入院后治疗费用、并发症率明显高于血清组,差异均有统计学意义(P<0.05),两组入院后疗效评价如致残率、死亡率、好转率比较,差异均无统计学意义(P>0.05).结论 实施血清危机干预方案,缓解血清难求的局面,为健全急救药储备体系提供依据.%Objective To explore the clinical effect of snake antivenins crisis intervention therapy to snakebite. Methods An analysis was performed: a comparison was made between a collection of 76 cases of antivenins crisis intervention therapy which was used as the intervention group for prospective observation period in between August 2008 and December 2011 and the other collection of 139 cases of procedural serum therapy which served for historical control period between November 2007 and August 2008. The comparison made included snake bite species, clinical classification, length of hospital stay, disability and mortality, and recovery, and etc. The data was analyzed by adopting chi-square test, and expressed by the measurement of mean±SD and t-test, with P0.05). Conclusion Implementation of antivenins crisis intervention therapy was aimed to ease the situation of antivenins shortage, and provide as reference for emergency medicine system.

  9. Management of Tissue Loss After Agkistrodon Snakebite: Appropriate Use of Crotalidae-Fab Antivenin.

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    Larson, Kenneth W; Schaefer, Keith R; Austin, Cindy; Norton, Rhy; Finley, Phillip J

    2016-01-01

    Although initially created for the treatment of rattlesnake (genus: Crotalus) bites, Crotalidae-Fab antivenin is used to treat many different pit viper envenomations. However, the efficacy of Crotalidae-Fab in preventing tissue loss from copperhead (Agkistrodon contortrix) or cottonmouth (Agkistrodon piscivorus) snakebites remains unclear. Recent reports show that Agkistrodon-related bites rarely require treatment beyond simple observation and pain control. The purpose of this study was to examine the amount of tissue loss in patients who received Crotalidae-Fab compared with those who did not after an Agkistrodon bite. After institutional review board approval, a retrospective study was completed at a Level 1 trauma center. Between 2009 and 2013, a total of 57 snakebites were identified. Of the 57 bites, the snake species was documented in 36 cases including 31 copperheads, 1 cottonmouth, and 4 rattlesnakes. The other 21 bites were from unknown or nonvenomous species. Of the 32 Agkistrodon-related bites, 15 patients received Crotalidae-Fab (average of 3 vials administered) and 17 did not receive Crotalidae-Fab. None of the 32 patients, regardless of treatment option, had tissue loss or required surgical interventions. Only 1 patient received Crotalidae-Fab and debridement of a vesicle associated with the bite. No clinically significant differences were observed between the groups. These findings support previous literature that failed to show added benefit of Crotalidae-Fab treatment for Agkistrodon bites beyond patient comfort and pain control. Evaluation of current protocols for Agkistrodon envenomations is warranted. Snakebite wound education in trauma physicians and nurses may decrease unnecessary use of antivenom medication.

  10. Comparación entre dos métodos de producción para la elaboración de antivenenos ofídicos Snake Antivenin: Comparison Between Two Production Methods

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    Adolfo Rafael de Roodt

    2010-06-01

    . Nevertheless, the treatment of venomous snakebites in domestic animals can turn diffcult due several problems among which, the conspicuous, is the low availability or lack of antivenoms for veterinary use. As commercial pressures on the pharmaceutical industry have led to a reduction in the production of antivenins in several parts of the world, their availability is sometimes rather limited and sometimes these products are impossible to obtain. In this work, we immunized horses with venom of South American vipers to obtain hyperimmune plasma. The plasma was processed to separate whole IgG of F(ab´2 fragments using two conventional methods (caprylic acid fractionation or double saline precipitation and pepsin digestion. The obtained antivenins were tested for their biochemical and immunochemical characteristics and neutralizing potency. The SDS-PAGE of the antivenins showed, in the processed antivenin, bands in the order of 150 and 100 kDa in the whole IgG or F(ab´2 fragments, respectively. The presence of albumin or contaminants of high or low molecular weight was not detected in any of the preparations. No important differences were observed in the neutralizing potency of the antivenins, although production cost was very low with the method used to obtain pure IgG. The low production cost makes the production of antivenins for veterinary use proftable when the production of F(ab´2 fragments is not possible.

  11. [Drug or plant substances which antagonize venoms or potentiate antivenins].

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    Chippaux, J P; Rakotonirina, V S; Rakotonirina, A; Dzikouk, G

    1997-01-01

    Dendroaspis jamesoni (Elapidae) and Echis oceliatus (Viperidae) are responsible for most of severe evenomation in Cameroon. Toxicity of venoms of these two species has been measured using mice according to the method of Spearman & Kàrber. The effect on experimental envenomation of various drugs (atropine, promethazine, neostigmine, hydrocortisone, pentosane sulfuric polyester, heparin, tranexamic acid and aminocaproic acid) and plant extracts (Schumanniophyton magnificum, Bidens pilosa, Securidaca longepedunculata and Garcinia lucida) has been observed associated or not with the antivenom lpser Afrique (SAV). The venom of D. jamesoni contains neurotoxins agonizing and antagonising acetylcholine. The toxicity of the venom did not depend on the route of injection. Atropine, promethazine, neostigmine and hydrocortisone protected animals against a venom dose up to 2 LD50. Moreover, atropine and promethazine potentiated the SAV. Similar results have been obtained with extracts from S. magnificum and B. pilosa. The venom of E. ocellatus induces haemorrhage and necrosis. The toxicity increased by 3-fold when the venom was injected through intravenous or intraperitoneal route, compared to intramuscular route. Pentosane sulfuric polyester and tranexamic acid protected mice against doses up to 3 LD50. Pentosane sulfuric polyester, hydrocortisone, heparin and aminocaproic acid increased the SAV protective titre by 50%. However, tried plant extracts weakly antagonised the venom and did not potentiate the SAV.

  12. Black widow spider (Latrodectus mactans) envenomation in a term pregnancy.

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    Sherman; Groll; Gonzalez; Aerts

    2000-07-01

    Description of a black widow spider (Latrodectus mactans) envenomation in a term pregnancy.Case report conducted at an Air Force tertiary care hospital of a 27-year-old primigravida at 38 1/7 weeks pregnancy.Latrodectus mactans antivenin can be given to treat symptoms of black widow envenomation.Black widow envenomations can cause symptoms associated with acute intra-abdominal processes. In pregnancy, envenomations can result in symptoms and signs similar to those seen in preeclampsia (abdominal pain, headache, hypertension, and proteinuria). Latrodectism should be considered in patients complaining of these symptoms in association with a spider bite. If latrodectism is considered to be the underlying origin for these symptoms, appropriate treatment should be administered. In cases of pregnancy, treatment should include L. mactans antivenin if believed to be clinically indicated. There is no current evidence that this antivenin is contraindicated in pregnancy. (Curr Surg 57:346-348)

  13. 21 CFR 610.53 - Dating periods for licensed biological products.

    Science.gov (United States)

    2010-04-01

    .... Albumin (Human) 3 years ......do (a) 5 years. ......do ......do (b) 3 years, provided labeling recommends...) Polyvalent ......do ......do 5 years with an initial 10 percent excess of potency, provided labeling... initial 10 percent excess of potency. Antivenin (Micurus fulvius) ......do ......do Do. Asparaginase...

  14. Presentation and treatment of venomous snakebites at a northern academic medical center.

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    Cowles, Robert A; Colletti, Lisa M

    2003-05-01

    Poisonous snakebites are relatively rare in the United States. The incidence of venomous snakebites is comparatively high in the southern states compared with the northern states and reports of these accidents from northern states is particularly uncommon. We report the experience with treatment of venomous snakebites at the University of Michigan over a 25-year period from 1976 to 2001. Six cases were identified and are described in detail. All patients were male and all were bitten in the upper extremity by pit vipers. One patient suffered a moderate envenomation and was treated with antivenin. Four other cases of mild envenomation occurred and two of these cases required antivenin therapy. One case was considered to represent a "dry" bite and required only 24-hour observation. There were no severe envenomations and no mortalities. On short-term follow-up all patients recovered without sequelae. This report demonstrates that venomous snakebites can be treated effectively at low-volume centers.

  15. Scorpion envenomation study in Behbahan County, Southwest Iran

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    Hamid Kassiri

    2014-05-01

    Full Text Available Objective: To study the incidence and epidemiology of scorpion sting cases that were referred to the health services centers of Behbahan County, Khuzistan Province, southwestern Iran, during the two yeare (2007-2008. Methods: In this descriptive retrospective research, the data has come from files of scorpionstung patients referring to the health services centers of Behbahan during study period. A special scorpion sting sheet was prepared and completed for every case of scorpion sting. Analysis of 3441 case sheets received during this period was carried out. The frequencies of medical and entomoepidemiologic parameters were turned to the percentage position. Results: A total of 3 441 cases of scorpion stings were reported during the two-year period from 2007 to 2008. The average incidence of scorpion stings was 8.8‰ in the two years. The frequency of cases was higher during August, September, June and July that 2 056 cases of scorpion stings were reported. Most stings were occurred during summer. Nearly 51.3% of the cases were men. All cases had received antivenin. Majority of scorpion sting cases (56.5% lived in the rural areas. The most common sting site was the hand. About 74.4% have received the antivenin 0-6 h after the sting. The early injection of the antivenin is very important. The most of the cases of scorpion stings (59% were occurred by yellow scorpions. Conclusions: Surveillance for cases of scorpion stings must begin at all regions of Behbahan County. Treatment of cases of scorpion stings is conducted according to a protocol set by the Ministry of Health, Treatment and Medical Education. This protocol included directions for lines of treatment and the dose of antivenin recommended. Thereafter all cases are referred to hospital for further observation and management.

  16. Scorpion envenomation study in Behbahan County, Southwest Iran

    Institute of Scientific and Technical Information of China (English)

    Hamid Kassiri; Ali Kassiri; Mona Sharififard; Samaneh Shojaee; Masoud Lotfi; Elnaz Kasiri

    2014-01-01

    Objective:To study the incidence and epidemiology of scorpion sting cases that were referred to the health services centers of Behbahan County, Khuzistan Province, southwestern Iran, during the two yeare (2007-2008). Methods: In this descriptive retrospective research, the data has come from files of scorpion-stung patients referring to the health services centers of Behbahan during study period. A special scorpion sting sheet was prepared and completed for every case of scorpion sting. Analysis of 3441 case sheets received during this period was carried out. The frequencies of medical and entomo-epidemiologic parameters were turned to the percentage position. Results:A total of 3 441 cases of scorpion stings were reported during the two-year period from 2007 to 2008. The average incidence of scorpion stings was 8.8‰in the two years. The frequency of cases was higher during August, September, June and July that 2 056 cases of scorpion stings were reported. Most stings were occurred during summer. Nearly 51.3%of the cases were men. All cases had received antivenin. Majority of scorpion sting cases (56.5%) lived in the rural areas. The most common sting site was the hand. About 74.4%have received the antivenin 0-6 h after the sting. The early injection of the antivenin is very important. The most of the cases of scorpion stings (59%) were occurred by yellow scorpions. Conclusions: Surveillance for cases of scorpion stings must begin at all regions of Behbahan County. Treatment of cases of scorpion stings is conducted according to a protocol set by the Ministry of Health, Treatment and Medical Education. This protocol included directions for lines of treatment and the dose of antivenin recommended. Thereafter all cases are referred to hospital for further observation and management.

  17. Effects of the canine rattlesnake vaccine in moderate to severe cases of canine crotalid envenomation

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    Leonard MJ

    2014-10-01

    Full Text Available McGee J Leonard,1 Catherine Bresee,2 Andrew Cruikshank1 1Animal Specialty and Emergency Center, Los Angeles, CA, USA; 2The Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA Abstract: This is a retrospective multicenter study (2006–2012 examining a population of dogs with moderate to severe crotalid envenomation for protective effects of the canine rattlesnake vaccine. Five nonacademic emergency and referral veterinary hospitals in Southern California were involved in the study and contributed records regarding a total of 82 client-owned dogs that were treated for naturally occurring rattlesnake envenomation. All dogs received antivenin (Crotalidae polyvalent, with dosages ranging from one to three vials (mean: 1.3±0.6. Fourteen dogs (17% had a history of prior vaccination against crotalid venom. In univariate logistic regression modeling, cases with lower body weight (P=0.0001 or higher snakebite severity scores (P<0.0001 were associated with greater morbidity. No statistically significant difference in morbidity or mortality between vaccinated and unvaccinated dogs was found. The findings of this study did not identify a significantly protective effect of previous vaccination in the cases of moderate to severe rattlesnake envenomation that require treatment with antivenin. Keywords: rattlesnake envenomation, vaccine, antivenin, canine

  18. Evaluation and treatment of poisonous snakebites.

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    Forks, T P

    1994-07-01

    Snakebite victims should be transported immediately to the nearest emergency department. Incision and suction are contraindicated unless performed by experienced personnel within five minutes of the bite, or unless transport of the patient to definitive medical care will take more than 30 minutes. Cryotherapy is contraindicated. All bites should be graded for severity of envenomation. The wound should be cleaned and broad-spectrum antibiotics administered. Tetanus status should be determined and tetanus toxoid administered if necessary. Antivenin is indicated in certain mild cases and in all moderate and severe cases of envenomation. Patients with a mild case of envenomation may require up to five vials of antivenin; patients with moderate bites may require 10 to 15 vials, and patients with severe bites may require 15 to 20 vials. Antivenin is effective only when administered intravenously; skin testing to predict the possibility of anaphylactic reaction is mandatory before administration. Diphenhydramine and epinephrine should be readily available in case of anaphylaxis. Fasciotomy is only indicated in rare cases involving elevated intracompartment pressures.

  19. Modulation of the Pharmacological and Biochemical Actions of Leiurusquinquestriatus (L.q) Scorpion Venom by Exposure to Gamma Radiation

    OpenAIRE

    Heba A. Mohamed*, Esmat A. Shaaban* , Aber M Amin** and Sanaa A. Kenawy

    2011-01-01

    This study was undertaken to evaluate the effect of gamma radiation (1.5 KGy & 3 KGy) on L.q scorpion venom. This was carried out by studying the toxicological, biochemical & immunological properties of the venom before and after exposure to gamma radiation. Material and methods Animals, venom, antivenin, gamma radiation, 125I. Results Data revealed that the toxicity of irradiated venom (1.5 KGy & 3 KGy) decreased as compared to that of the native one. LD50 of irradiated venom were 3.5 mg/kg ...

  20. Progress and improvement of the manufacturing process of snake antivenom

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    Zolfagharian H.

    2013-05-01

    Full Text Available Antivenoms have been used successfully for more than a century and up to now constitute the only effectivetreatment for snakebites .The production of antivenin started long time ago when the calmette was preparedthe antivenom in 1894.The method currently used to prepare antivenom by most of the manufacturers areoriginated from the method of Pope which was develop in 1938. Several new approaches in the production ofantivenom have been proposed to produce IgG, F(ab2, F(ab antivenin to improve their quality .Theseimprovement include complete or partial modification in the antivenom production regarding animal,immunization protocols , new adjuvants in hyperimmunization of animals , purification processes ( caprylicacid ,chromatography , diafiltration and ulterafiltration ,enzymatic digestion of IgG (pepsin, papain andfractionation of venom .When the IgG is digested enzymatically, different fragments are obtained depending on the enzyme used, that is, if papain is used, three fragments are obtained, the crystallizing fragment (Fc and two antigen-binding fragments F(ab and, if pepsin is used, one F(ab'2 fragment is obtained, while thecrystallizing fragment is digested. Fab and F(ab2 fragments conserve their capacity to specifically bind to the antigen that gave rise to them.

  1. Venomous snakebite in Thailand. I: Medically important snakes.

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    Chanhome, L; Cox, M J; Wilde, H; Jintakoon, P; Chaiyabutr, N; Sitprija, V

    1998-05-01

    Thailand has an abundance of venomous snakes. Among the neurotoxic family Elapidae, there are three species of the genus Naja (cobras), three of the genus Bungarus (kraits), and the king cobra of the genus Ophiophagus. Other Elapidae snakes in Thailand include sea snakes and Asian coral snakes of the genus Calliophis. They have potent venoms but rarely bite humans. Tissue and hemotoxic snakes are represented by family Viperidae, subfamilies Viperinae and Crotalinae. They remain an occupational hazard for farmers and rubber tappers, causing serious morbidity but only rare deaths, since competent treatment is now widely available throughout Thailand. Purified equine antivenin is manufactured locally for the monocled and Siamese spitting cobras (Naja kaouthia and N. siamensis), king cobra (Ophiophagus hannah), banded krait (Bungarus fasciatus), most green pit vipers (Trimeresurus sp.), Malayan pit viper (Calloselasma rhodostoma), and the Siamese Russell's viper (Daboia russelli siamensis).

  2. The absence of antagonism between extracts of Clinacanthus nutans Burm. and Naja naja siamensis venom.

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    Cherdchu, C; Poopyruchpong, N; Adchariyasucha, R; Ratanabanangkoon, K

    1977-06-01

    Clinacanthus nutans Burm, a herb reputed in Thailand and Malaysia to be "snakebite antidote" has been tested in vitro and in vivo for antivenin activity. The aqueous extract of C. nutans leaves has been found to have no effect on the inhibition of neuromuscular transmission produced by purified Naja naja siamensis neurotoxin in isolated rat phrenic-nerve diaphragm preparations. The extract of C. nutans, when given orally or intraperitoneally, are ineffective in prolonging the survival time of experimental mice receiving lethal doses of N.n. siamensis crude venom. Oral administrations of the herb extracts pretreated with alpha-amylase or beta-amylase also fail to protect the animal. It is concluded that the extract of C. nutans can not antagonize the action of cobra venom.

  3. [Retrospective study on Latrodectus stings in Bahia, Brazil].

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    Lira-da-Silva, R M; Matos, G B; Sampaio, R O; Nunes, T B

    1995-01-01

    This work is a retrospective study of latrodectism in the State of Bahia, Brazil, from August 1980 to July 1990. The data concerning the accidents were obtained from file cards at the Antivenom Information Center of Bahia (AVICB). Latrodectus curacavienis was the ethiologic agent identified in 28% of the arachnid accidents. The major incidence was registered in urban area (57%) affecting men (70%) more than women, with 10 to 29 year-old age group (58%). Local pain (56%), erythematous papula (29%) and light oedema (17%) were the principal local symptoms. Pain in the limbs (29%), tremor and rigidities (29%), sweating (28%), limbs and arms paresthesia (21%) and abdominal pain (17%) were systemic ones. The treatment was mainly symptomatic (67%) and antivenin serum was used in 21% of the cases. After serotherapy, 64% of the patients left the hospital within less than 24 hours.

  4. Clinical Aspects and Emergent Management of Snake Bites Presented to Emergency Department

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    Bedriye Sonmez

    2014-03-01

    Full Text Available Aim: Evaluating the epidemiologic characteristics and management of snake bites presenting to emergency departments. Material and Method: In this retrospective study 74 cases of snakebites admitted to Emergency Department of Diyarbakir Training and Research Hospital between 2008 and 2009 were retrospectively evaluated. Results: Fourty-six (62.2% of patients were male and 28 (37.8% were female. Mean age of the study population was 34.85±19.17 (min 7- max 80 years. Most of the snakebites occurred between 18.00 to 06.00 hours and at home (73%. 79.7% of snake bites occurred to upper extremities. %93 of cases had intravenous administration of antivenin (one dose. Neither none of the patients needed recurrent administration. Discussion: Snake bites are still a major public health problem especially in rural areas. Particularly emergency care physicians should be adequately capable and sophisticated in multidisciplinary management of snake bites.

  5. [Accidents with venomous and poisonous animals in Central Europe].

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    Bodio, Mauro; Junghanss, Thomas

    2009-05-01

    Central Europe is largely safe from accidents with venomous and poisonous animals. The regions where European vipers are regularly found are shrinking. Today accidents with jellyfish and stings of venomous fish afflicted during leisure activities at the sea side play the dominant role. Life threatening accidents in Europe are mainly due to exotic snakes held in captivity. A system useful in daily medical practice is explained to classify and stage accidents due to poisonous and venomous animals. The important poisonous and venomous animals of Central Europe and the specific therapeutics, the antivenoms, are covered. The antivenom depot "Antivenin-CH" of the Swiss Toxicology Information Centre in Zurich and the MRITox in Munich with the antivenom registry Munich AntiVenom INdex (MAVIN) are presented.

  6. [Envenomation and poisoning by venomous or poisonous animals. VII: arachnidism in the New World].

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    Chippaux, J P; Alagón, A

    2008-06-01

    The incidence of scorpion stings and spider bites is high in Latin America. This is particularly true for Mexico, part of Amazonia, and southern and eastern Brazil. Centruroides and Tityus scorpion stings present a real danger for humans, especially children. Envenomation results in intense pain, neurological signs, and cardiorespiratory manifestations that can lead to death by acute pulmonary edema or heart failure. In the event of confirmed envenomation, antivenin must be administered as soon as possible in association with symptomatic treatment and, if necessary, cardiorespiratory resuscitation. Spider bites are a less frequent and severe. Envenomation by Loxosceles is extremely painful and necrotizing. Severe visceral complications can develop. An effective antivenim has recently become available for local and systemic envenomation. Envenomation by Latrodectus leads to neurological symptoms that can also be treated with antivenom. Envenomation by other spiders is less frequent and generally harmless.

  7. A review of chemistry and biological activities of the genus Aerva--a desert plant.

    Science.gov (United States)

    Chawla, Payal; Chawla, Amit; Vasudeva, Neeru; Sharma, Surendra Kumar

    2012-01-01

    There are approximately 28 species of Aerva genus, but only a few species are medicinal of which A. persica, A. lanata and A. javanica are of great value. A number of flavonol glycosides (e.g., aervanone, kaempferol-3-galactoside, isorhamnetin-3-O-β-D-glucoside) have been reported from Aerva persica as major phytoconstituents and the minor constituents are β-cyanins (glycine betaine and trigonelline), sterols and carbohydrates. This plant is used as medicinal herb in several traditional systems of medicine all over the world, like diuretic, demulcent, purgative, emetic and tinder. Aerva plants are used to cure ulcer, lithiasis, dropsical affections, eye affection, toothache, headache, in disorders of abdomen and inflammation of internal organs. Roots and flowers are reported to possess hypoglycemic, antioxidant, anthelmintic, analgesic, antimalarial, antivenin activities and medicinal properties against rheumatism and kidney troubles.

  8. Alleviation of viper venom induced platelet apoptosis by crocin (Crocus sativus): implications for thrombocytopenia in viper bites.

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    Santhosh, M Sebastin; Thushara, R M; Hemshekhar, M; Sunitha, K; Devaraja, S; Kemparaju, K; Girish, K S

    2013-11-01

    Viper envenomations are characterized by prominent local and systemic manifestations including hematological alterations. Snake venom metalloproteinases (SVMPs) and phospholipase A2 (PLA2) plays crucial role in the pathophysiology of hemorrhage by targeting/altering the platelets function which may result in thrombocytopenia. Platelets undergo the classic events of mitochondria-mediated apoptotic pathway due to augmented endogenous reactive oxygen species (ROS) levels. The observed anticoagulant effects during viper envenomations could be due to exacerbated platelet apoptosis and thrombocytopenia. Moreover, antivenin treatments are ineffective against the venom-induced oxidative stress; therefore, it necessitates an auxiliary therapy involving antioxidants which can effectively scavenge the endothelium-generated/endogenous ROS and protect the platelets. The present study explored the effects of viper venom on platelet apoptosis and its amelioration by a phytochemical crocin. The study evaluated the Vipera russelli venom-induced apoptotic events including endogenous ROS generation, intracellular Ca(2+) mobilization, mitochondrial membrane depolarization, cyt-c translocation, caspase activation and phosphatidylserine externalization which were effectively mitigated when the venom was pre-treated with crocin. The study highlights one of the less studied features of venom-induced secondary complications i.e. platelet apoptosis and sheds light on the underlying basis for venom-induced thrombocytopenia, systemic hemorrhage and in vivo anticoagulant effect.

  9. Propensity of crocin to offset Vipera russelli venom induced oxidative stress mediated neutrophil apoptosis: a biochemical insight.

    Science.gov (United States)

    Santhosh, M Sebastin; Sundaram, M Shanmuga; Sunitha, K; Jnaneshwari, S; Devaraja, S; Kemparaju, K; Girish, K S

    2016-01-01

    Viper envenomation results in inflammation at the bitten site as well as target organs. Neutrophils and other polymorphonuclear leukocytes execute inflammation resolving mechanism and will undergo apoptosis after completing the task. However, the target specific toxins induce neutrophil apoptosis at the bitten site and in circulation prior to their function, thus reducing their number. Circulating activated neutrophils are major source of inflammatory cytokines and leakage of reactive oxygen species (ROS)/other toxic intermediates resulting in aggravation of inflammatory response at the bitten/target site. Therefore, neutralization of venom induced neutrophil apoptosis reduces inflammation besides increasing the functional neutrophil population. Therefore, the present study investigates the venom induced perturbances in isolated human neutrophils and its neutralization by crocin (Crocus sativus) a potent antioxidant carotenoid. Human neutrophils on treatment with venom resulted in altered ROS generation, intracellular Ca(2+) mobilization, mitochondrial membrane depolarization, cyt-c translocation, caspase activation, phosphatidylserine externalization and DNA damage. On the other hand significant protection against oxidative stress and apoptosis were evidenced in crocin pre-treated groups. In conclusion the viper venom induces neutrophil apoptosis and results in aggravation of inflammation and tissue damage. The present study demands the necessity of an auxiliary therapy in addition to antivenin therapy to treat secondary/overlooked complications of envenomation.

  10. Inventing an arsenal: adaptive evolution and neofunctionalization of snake venom phospholipase A2 genes

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    Lynch Vincent J

    2007-01-01

    Full Text Available Abstract Background Gene duplication followed by functional divergence has long been hypothesized to be the main source of molecular novelty. Convincing examples of neofunctionalization, however, remain rare. Snake venom phospholipase A2 genes are members of large multigene families with many diverse functions, thus they are excellent models to study the emergence of novel functions after gene duplications. Results Here, I show that positive Darwinian selection and neofunctionalization is common in snake venom phospholipase A2 genes. The pattern of gene duplication and positive selection indicates that adaptive molecular evolution occurs immediately after duplication events as novel functions emerge and continues as gene families diversify and are refined. Surprisingly, adaptive evolution of group-I phospholipases in elapids is also associated with speciation events, suggesting adaptation of the phospholipase arsenal to novel prey species after niche shifts. Mapping the location of sites under positive selection onto the crystal structure of phospholipase A2 identified regions evolving under diversifying selection are located on the molecular surface and are likely protein-protein interactions sites essential for toxin functions. Conclusion These data show that increases in genomic complexity (through gene duplications can lead to phenotypic complexity (venom composition and that positive Darwinian selection is a common evolutionary force in snake venoms. Finally, regions identified under selection on the surface of phospholipase A2 enzymes are potential candidate sites for structure based antivenin design.

  11. Ten years of snakebites in Iran.

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    Dehghani, Rouhullah; Fathi, Behrooz; Shahi, Morteza Panjeh; Jazayeri, Mehrdad

    2014-11-01

    Many species of venomous snakes are found in Iran. The most medically important species which are responsible for the most snakebite incidents in Iran belong to the Viperidae family, including Vipera lebetina, Echis carinatus, Pseudocerastes persicus, Vipera albicornuta and the Elapidae family, especially Naja naja oxiana. At least one kind of venomous snake is found in each of the 31 provinces, and many provinces have more than one venomous species. As a result, snakebite is a considerable health hazard in Iran, especially in the rural area of south and south-west of Iran. A retrospective, descriptive study of snakebite in Iran during 2002-2011 was carried out in order based on data collected from medical records of bite victims admitted to hospitals and health centers. From 2002 to 2011, 53,787 cases of snake bites were reported by medical centers in Iran. The annual incidence of snake bites in 100,000 of population varied from 4.5 to 9.1 during this decade and the number of recorded deaths were about 67 cases. The highest rate of snakebite was found in provinces of south and southwest of Iran. We suggest that people, especially in the rural areas, need to be trained and educated about venomous snakes, their hazards, prevention of bite and the importance of early hospital referral and treatment of victims. Also adequate antivenins as the main life saving medicine should be made available based on the recorded numbers of victims in each area of the country.

  12. Aspectos epidemiológicos e clínicos dos acidentes ofídicos ocorridos nos municípios do Estado do Amazonas Epidemiological and clinical aspects of snake accidentes in the municipalities of the State of Amazonas, Brazil

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    Célio Campos Borges

    1999-12-01

    municipality (70.2%. The local signs and symptoms most frequently observed in those who received medical care more than 6 hours after the accident (57.3% were edema (76.9%, pain (68.7%, erithema (10.2% and hemorrhage (9.3%. The systemic manifestation most frequently observed was hemorrhage (18.8%. Serotherapy was administered in only 65.9% of patients, the intravenous route being the route most commonly used to administer the antivenin (52.3%, while other non- recommended routes were widely used. In the majority of patients the antivenin given was antibotropic. The most frequent complications were: abscess 13.7%, necrosis 12.3%, secondary infection 8.3%, renal insufficiency 2.5% and gangrene 2.5%. The medical procedures most used in the treatment of these complications were drainage 52.6%, debridement 28.9%, amputation 10.5%, surgical cleaning 5.3% and peritoneal dialysis 2.6%. The fatality rate was 1%.

  13. Acidente crotálico na infância: aspectos clínicos, laboratoriais, epidemiológicos e abordagem terapêutica

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    Palmira Cupo

    1991-06-01

    Full Text Available Foram atendidas no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto/USP, durante os anos de 1980 a 1989, 21 crianças vítimas de acidente crotálico, 16 das quais apresentaram sinais clínicos de envenenamento grave à admissão e 5, de envenenamento moderado. Quatro pacientes (20% desenvolveram necrose tubular aguda, dois dos quais necessitaram métodos dialíticos. Um paciente (5% foi a óbito no 13.° dia do acidente, após intercorrências graves, como hemorragia digestiva e insuficiência respiratória aguda. São apresentadas as características clínicas, laboratoriais e epidemiológicas do acidente crotálico nesses pacientes, enfatizando os conhecimentos atuais sobre a fisiopatologia do envenenamento por Crotalus durissus terrificus. Ao mesmo tempo, pretendeu-se contribuir para a correta abordagem terapêutica, no que diz respeito ao emprego adequado do soro antiveneno e à prevenção da necrose tubular aguda, a mais séria e grave complicação do acidente crotálico.At the Hospital of Clinics of the Faculty of Medicine of Ribeirão Preto/USP during the years 1980-1989 21 children have been attended after rattlesnake bite: 16 severe and 5 with moderate envenomation. Four (20% developed acute tubular necrosis 2 necessitating dialysis. One patient died 13 days after the bite and grave complications including digestive hemorrhage and acute respiratory insuficiency. All patients preserved clinical laboratory and epidemiological characteristics of Crotalus durissus terrificus envenomation. We also comment on the correct management of such patients specially related to antivenin dosage and the prevention ofacute tubular the most serious complication of such an accident.

  14. Estudo retrospectivo de latrodectismo na Bahia, Brasil

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    Rejâne Maria Lira-da-Silva

    1995-09-01

    Full Text Available O trabalho apresenta um estudo retrospectivo de setenta e sete casos de latrodectismo no Estado da Bahia, Brasil, de agosto de 1980 a julho de 1990. Os dados foram levantados nos livros de registro e arquivo de fichas do CIAVE. O agente etiológico em 28% dos acidentes aracnídeos foi a espécie L. curacaviensis e a maior incidência foi registrada no meio urbano (57%, em indivíduos do sexo masculino (70% e faixa etária de 10 a 29 anos (58%. Os principais sinais locais foram dor (56%, pápula eritematosa (21% e edema discreto (17%, e os sistêmicos foram dor em membros inferiores (29%, tremores e contraturas (29%, sudorese (28% parestesia em membros (21% e dor abdominal (17%. O tratamento foi sintomático em 67% dos casos e específico em 21%. O tempo de permanência hospitalar após o uso do soro antilatrodectus foi menor que 24 horas em 64% dos casos.This work is a retrospective study of latrodectism in the State of Bahia, Brazil, from August 1980 to July 1990. The data concerning the accidents were obtained from file cards at the Antivenom Information Center of Bahia (AVICB. Latrodectus curacavienis was the ethiologic agent identified in 28% of the arachnid accidents. The major incidence was registered in urban area (57% affecting men (70% more than women, with 10 to 29year-old age group (58%. Local pain (56%, erythematous papula (29% and light oedema (17% were the principal local symptoms. Pain in the limbs (29%, tremor and rigidities (29%, sweating (28%, limbs and arms paresthesia (21% and abdominal pain (17% were systemic ones. The treatment was mainly symptomatic (67% and antivenin serum was used in 21% of the cases. After serotherapy, 64% of the patients left the hospital within less than 24 hours.

  15. Antihaemolytic and snake venom neutralizing effect of some Indian medicinal plants

    Institute of Scientific and Technical Information of China (English)

    Chidambaram Kumarapppan; Albert Jaswanth; Karpagam Kumarasunderi

    2011-01-01

    Objective:To validate traditional claims of usefulness of the Indian plants in management of poisonous snakebite and evaluate the antivenom properties displayed by the alcoholic extracts ofAndrographis paniculata (A. paniculata),Crateva magna (C. magna),Gloriosa superba (G. superba) andHydrocotyle javanica (H. javanica).Methods:These plants were collected, identified and the extracts were prepared by using conventional Soxhlet ethanol extraction technique. The venom neutralization activity was accessed in mice (20-25g) and number of mortalities was observed against clinically important snake (Naja nigricollis) venom. Present study also deals with in vitro membrane stabilizing activity of these plants against hyposaline induced human red blood corpuscles(HRBC).Results: Extracts ofH. javanica andG. superba gave80 % and90 %protection to mice treated with minimum lethal dose of venom (LD99). These two plants showed significant neutralization effect against the venoms of Naja nigricollis venom.H. javanica andG. superba(25-100 mg/mL) produced significant changes of membrane stabilization of human red blood cells(HRBC)exposed to hyposaline-induced haemolysis.Conclusions:We conclude that probably due to presence of various phytochemicals plays an important role in the anti-venom potential of these Indian medicinal plants against Naja nigricollis venom. The above observations confirmed thatA. paniculata, C. magna, G. superba andH. javanica plant extracts possess potent snake venom neutralizing capacity and could potentially be used as an adjuvants for antivenin therapy in case of snakebite envenomation, especially against the local effects of cobra venoms.

  16. An Important Ethnomedicinal Plant Balanite Aegyptiaca Del.

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    Shweta Suresh Saboo

    2014-06-01

    Full Text Available For centuries traditional medical systems (TMS were the primary medical system in the countries of origin, and now nevertheless the present dominance of the Western scientific medical model, citizens and health-caregivers are starting to rely and trust TMS. The usage of herbs to treat a variety of different ailments is universal, and exists in every human culture on Earth different Ethno medicinally important plant are available in our surrounding which having lot’s of medicinal importance .in this paper we are focusing on importance of  Balanites aegyptiaca Del., also known as ‘Desert date’ Synonyms: Ximenia aegyptiaca L. family Zygophyllace,. Balanites aegyptiaca Del Ethnobotinical it’s reported as a good  jaundice, intestinal worm infection, wounds, malaria, syphilis, epilepsy, dysentery, constipation, diarrhea, hemorrhoid, stomach aches, asthma, and fever It is distributed tropical areas,  Balanites aegyptiaca Del manly cultivated by seedling and propagation. In this paper we are also discussing about morphological character of Leaves, Flowers , Habit  , Diagnostic characters .chemically also it’s very enriched plant the number of Chemical constituents like protein, lipid, carbohydrate, alkaloid, saponin, flavonoid, and organic acid quercetin-3-rutinoside;furanocoumarin bergapten and dihydrofuranocumarin D- marmesin, ,  beta-sitosterol, bergapten, marmesin, and beta-sitosterol glucoside,balanitin-1,-2, and -3 , Balanitoside yamogenin, scientifically this plant is reported as good Anthelmintic activity, Antibacterial activity, Antivenin activity, Anticancer activity Anti-inflammatory and analgesic activity, In vitro antioxidant, xanthine oxidase and acetylcholinesterase inhibitory activities, antinociceptive , Antidiabetic activity Antiviral activity Wound healing activity, Hypocholesterolemic activity, Diuretic activity.

  17. Mechanisms involved in the nociception triggered by the venom of the armed spider Phoneutria nigriventer.

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    Camila Gewehr

    Full Text Available BACKGROUND: The frequency of accidental spider bites in Brazil is growing, and poisoning due to bites from the spider genus Phoneutria nigriventer is the second most frequent source of such accidents. Intense local pain is the major symptom reported after bites of P. nigriventer, although the mechanisms involved are still poorly understood. Therefore, the aim of this study was to identify the mechanisms involved in nociception triggered by the venom of Phoneutria nigriventer (PNV. METHODOLOGY/PRINCIPAL FINDINGS: Twenty microliters of PNV or PBS was injected into the mouse paw (intraplantar, i.pl.. The time spent licking the injected paw was considered indicative of the level of nociception. I.pl. injection of PNV produced spontaneous nociception, which was reduced by arachnid antivenin (ArAv, local anaesthetics, opioids, acetaminophen and dipyrone, but not indomethacin. Boiling or dialysing the venom reduced the nociception induced by the venom. PNV-induced nociception is not dependent on glutamate or histamine receptors or on mast cell degranulation, but it is mediated by the stimulation of sensory fibres that contain serotonin 4 (5-HT4 and vanilloid receptors (TRPV1. We detected a kallikrein-like kinin-generating enzyme activity in tissue treated with PNV, which also contributes to nociception. Inhibition of enzymatic activity or administration of a receptor antagonist for kinin B2 was able to inhibit the nociception induced by PNV. PNV nociception was also reduced by the blockade of tetrodotoxin-sensitive Na(+ channels, acid-sensitive ion channels (ASIC and TRPV1 receptors. CONCLUSION/SIGNIFICANCE: Results suggest that both low- and high-molecular-weight toxins of PNV produce spontaneous nociception through direct or indirect action of kinin B2, TRPV1, 5-HT4 or ASIC receptors and voltage-dependent sodium channels present in sensory neurons but not in mast cells. Understanding the mechanisms involved in nociception caused by PNV are of

  18. Neutralization effects of Iranian Vipera lebetina biological properties by Razi institute antivenom

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    Ramin Seyedian

    2013-09-01

    Full Text Available Background: The hemotoxic and neurotoxic factors of snake venoms is the main responsible for necrosis and tissue sloughing. Envenomations are common in rural areas in all provinces of Iran caused by snake species which causes local swelling, ecchymosis and alterations in blood profile in case of hemotoxic venom. In this study some in vivo and in vitro properties (Hemorrhagic, edematogenic and coagualant of Iranian Vipera lebetina venom in addition to neutralizing capacity of pepsin derived Razi Institute polyvalent antivenin were assayed. Material and Methods: Escalating doses of Vipera lebetina venom dissolved in Normal saline (2.5-50 µg/ml were injected (100µl subcutaneously to dorsal area of rats (n=3 to investigate mean hemorrhagic amount after 24 hours.Groups of three mice were injected subcutaneously in the right foodpad with various amounts of venom (10-150µg.The left foodpad received the same amount (100µl ofnormal saline alone (negative control to evaluate the edematogenic property of this venom. To determine the coagulant activity, various amounts of venom dissolved in normal saline (50µl were added to human plasma (200µl and coagulation time was measured. Razi Institute antivenom was used for neutralization of all three measured biological parameters. Results: Mean hemorrhagic, procoagulant and edematous amounts (increasing 30% in hind paw edema were 8.5, 1.1 and 70 microgram, respectively. Preincubation with polyvalent antibody (30 and 200 microliter decreased hemorrhagic and procoagulant activity. Edematogenic property of this venom decreased significantly by incubation with antivenom (78% to 38% by incubation with 1000 microliter of polyvalent antivenom. Intra peritoneal injection of this remedy following envenomation had no effect in relieving symptoms. Myonecrotic effects were seen by intramuscular injection of Vipera lebetina venom in rats. Conclusion: Our study shows that Iranian antivenom could neutralize some in vivo

  19. Scorpion stings in Turkey: epidemiological and clinical aspects between the years 1995 and 2004 Picadas de escorpião na Turquia: aspectos epidemiológicos e clínicos entre os anos de 1995 e 2004

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    Yıldırım Cesaretli

    2010-08-01

    Full Text Available The most important health-threatening scorpions found in Turkey are; Androctonus crassicauda, Leiurus quinquestriatus, Mesobuthus gibbosus and M. eupeus species, all of which belong to the Buthidae family. The epidemiological and clinical findings of scorpion stings in Turkey were evaluated between the years 1995 and 2004 based on data recorded in the National Poison Information Center (NPIC. A total of 930 cases were recorded. The cases mostly occurred in the month of July. The gender distribution was 50.22% female and 45.48% male. It was shown that the 20-29 age group presented more scorpion stings. Most of the stings occurred in Central Anatolia and Marmara regions of Turkey. Patients at the hospital showed signs of localized (pain, hyperemia, edema and numbness and systemic effects (hyperthermia, nausea and vomiting, tachycardia, shivering and lethargy but no lethality was notified. According to records, 33% of the poisoned patients were treated with antivenin in healthcare facilities.Os mais importantes escorpiões que comprometem a saúde na Turquia são: Androctonus crassicauda, Leiurus quinquestriatus, Mesobuthus gibbosus e M. eupeus, todos eles pertencentes à família Buthidae. Os achados clínicos e epidemiológicos da picada de escorpiões na Turquia foram avaliados no período entre os anos de 1995 a 2004 baseados em dados do Centro Nacional de Informações de Envenenamentos (NPIC. Foram registrados 930 casos que ocorreram principalmente no mês de julho. A distribuição por sexo foi 50,22% femininos e 45,48% masculinos. Demonstrou-se que o grupo etário de 20 a 29 anos apresentou maior número de picadas de escorpião. A maior parte das picadas ocorreu na Anatólia Central e na região de Marmara, na Turquia. Os pacientes hospitalizados mostraram sinais localizados (dor, hiperemia, edema e confusão mental e sistêmicos (hipertermia, náusea e vômitos, taquicardia, arrepios de frio e letargia, mas não houve notificação de