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Anticholinesterase Agents: Poisoning and Treatment

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Anticholinesterases, also known as cholinesterase inhibitors, work by blocking the breakdown of acetylcholine, leading to its accumulation in the synaptic cleft. This accumulation indirectly enhances both muscarinic and nicotinic actions. These agents are classified as reversible or irreversible based on their mechanism of action.
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Harvesting Venom Toxins from Assassin Bugs and Other Heteropteran Insects

Harvesting Venom Toxins from Assassin Bugs and Other Heteropteran Insects

Published on: April 21, 2018

The Australian Snakebite Project, 2005-2015 (ASP-20).

Christopher I Johnston¹, Nicole M Ryan², Colin B Page³

¹NSW Poisons Information Centre, Sydney Children's Hospitals Network, Sydney, NSW geoff.isbister@gmail.com.

The Medical Journal of Australia

|August 3, 2017

Summary

Snake envenoming in Australia is uncommon but can be severe. While antivenom use has decreased without harm, snake venom detection kits are unreliable, necessitating improved early diagnosis.

Keywords:

Adverse drug reactions Antivenoms Envenomation Rural health services Snakebites

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Area of Science:

Toxicology
Epidemiology
Clinical Medicine

Background:

Snakebite envenoming represents a significant public health concern in Australia.
Understanding the epidemiology and clinical outcomes of snakebites is crucial for effective management.

Purpose of the Study:

To detail the epidemiology, treatment strategies, and adverse events associated with snakebite envenoming in Australia.
To evaluate the effectiveness and reliability of snake venom detection kits (SVDKs).

Main Methods:

A prospective, multicentre study involving 1548 patients with suspected snakebites from 2005-2015.
Data collection included demographics, bite circumstances, clinical effects, laboratory results, SVDK testing, antivenom treatment, and outcomes.

Main Results:

835 patients experienced envenoming, with brown snakes being the most frequent cause (41%).
Common clinical effects included coagulopathy (73%), myotoxicity (17%), and acute kidney injury (12%). Severe complications like cardiac arrest (2.9%) and major hemorrhage (1.6%) occurred.
Snake venom detection kits demonstrated low reliability, with significant incorrect results and false positives. Antivenom hypersensitivity reactions occurred in 24% of recipients.

Conclusions:

Snake envenoming in Australia, though infrequent, can lead to severe outcomes.
Snake venom detection kits are unreliable for snake identification.
Reduced antivenom dosage has not negatively impacted patient outcomes, but delays in treatment persist, highlighting the need for improved diagnostic approaches.