Heloderma suspectum envenomation

 

Bitten injury by Heloderma suspectum

希拉毒蜥 咬傷

 

SUBSTANCE

-The venom contains some protein and nonprotein components including serotonin, a bradykinin-releasing substance, protease, hyaluronidase, helodermin, and gilatoxin. [1]

下巴兩側有毒腺 

Common name / Trade name

-  Gila monster    

- Heloderma suspectum

- 希拉毒蜥

- The kallikrein-like activity of Heloderma venom is inhibited by carbon monoxide [2]

 

Involving SYSTEM

 

-          most (79%) occurred in males [3].  

-          Airway, angioedema. [4].

-          GI, diarrhea, nausea, vomiting [4, 5].

-          CV, hypotension, cardiac ischemia. [4]

-          Systemic, pain, diaphoresis. [1]

 

Presentation

 

-angioedema which can lead to respiratory tract obstruction [4]

-significant fluid losses due to diarrhea, vomiting, and sweating, associated with hypokalemia and sometimes metabolic acidosis [4, 5]

- atrioventricular conduction disorders simulating cardiac ischemia [4]

- hypotensive, and in shock [1, 5]

- atrial fibrillation requiring electrical cardioversion [5]

- pain, edema, nausea, vomiting, weakness, and diaphoresis. [1]

 

Antidote / Treatment

 

-There is no antivenom [1, 4]

-the treatment is only symptomatic and supportive. [4]

- Cryotherapy, tourniquet, and excision are dangerous and should not be used [1].

 

 

Disposition

- at least 6 hours of observation after the bite to assess [6]

- Majority of cases did not require hospitalization. [3]

- Heloderma bite are quite rare and generally mild. Few severe cases may require emergency resuscitation [4].

- (51%) were discharged home.

- (24%) were ED observation

-  15.6% admissions to an intensive care unit (ICU) [3].

-  Mortality rate: 0% till June 2024, not yet fatal report on PubMed. [3]

 

REFERENCES

 

1.      Strimple PD, Tomassoni AJ, Otten EJ, Bahner D. Report on envenomation by a Gila monster (Heloderma suspectum) with a discussion of venom apparatus, clinical findings, and treatment. Wilderness Environ Med. 1997 May;8(2):111-6. doi: 10.1580/1080-6032(1997)008[0111:roebag]2.3.co;2. PMID: 11990142.

2.      Nielsen VG, Frank N. The kallikrein-like activity of Heloderma venom is inhibited by carbon monoxide. J Thromb Thrombolysis. 2019 May;47(4):533-539. doi: 10.1007/s11239-019-01853-6. PMID: 30955141.

3.      French R, Brooks D, Ruha AM, Shirazi F, Chase P, Boesen K, Walter F. Gila monster (Heloderma suspectum) envenomation: Descriptive analysis of calls to United States Poison Centers with focus on Arizona cases. Clin Toxicol (Phila). 2015 Jan;53(1):60-70. doi: 10.3109/15563650.2014.988791. Epub 2014 Dec 16. PMID: 25511795.

4.      Chippaux JP, Amri K. Severe Heloderma spp. envenomation: a review of the literature. Clin Toxicol (Phila). 2021 Mar;59(3):179-184. doi: 10.1080/15563650.2020.1853145. Epub 2020 Dec 2. PMID: 33263449.

5.      Amri K, Chippaux JP. Report of a severe Heloderma suspectum envenomation. Clin Toxicol (Phila). 2021 Apr;59(4):343-346. doi: 10.1080/15563650.2020.1804574. Epub 2020 Aug 7. PMID: 32762570.

6.      Hooker KR, Caravati EM, Hartsell SC. Gila monster envenomation. Ann Emerg Med. 1994 Oct;24(4):731-5. doi: 10.1016/s0196-0644(94)70285-3. Erratum in: Ann Emerg Med 1995 Jan;25(1):47. PMID: 8092603.

 

14 July, 2024 edited by Yu-Jang Su