Animal poisons - includes venomous snakes, scorpions, spiders, ants, wasps, spanish fly and centipedes. Signs and symptoms, diagnosis, first aid and medical management in case of bites and stings.

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2.  Snakes
 Scorpion
 Cantharides (Spanish fly)
 Spiders
 Centipedes
 Bees and Wasps
 Ants
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3.  Snakes are elongate, legless, carnivorous
reptiles of suborder Ophidia
 3,500 species of snakes in the world of which
only 350 species are venomous
 In India, 330 species of snakes are seen of
which 70 species are venomous
 Venom: toxic only when injected not when
ingested
 Poison: poisonous when ingested as well as
injected
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4. TRAIT VENOMOUS NON-VENOMOUS
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5.  ‘Big four’ snakes:
1. Saw scaled viper
2. Russel’s viper
3. Common cobra
4. Common krait
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6.  Also called: afai (H); trachu paamu (T)
 Smallest of the big four. Responsible for maximum
snakebite cases and deaths
 90 cm in length
 Head: short, wide, pear shaped
 Snout: short and rounded
 Head: triangular
 Dorsal scales: mostly ridged or keeled. Ridge is
dented like a saw; hence the name
 Belly scales: broad with brown or dark spots
 Tail: short and tapering
 Produces a sizzling sound by keeled scales
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7. Ridged scales
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8.  Also called: Daboia (H); Rakta penjari (T)
 Head: Flat heavy triangular head with white ‘V’
shaped mark, angle of V pointing forwards
 Colour: Brown
 Has 3 rows of diamond shaped black or brown
spots
 Behaviour: commonly biting snake, hisses loudly
and continuously
 Ovoviviparous
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9. V-shaped
mark on head
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10.  Also called: Naag, Kala saanp (H); Naagu paamu (T)
 Colour: Brown or dark
 Hood: most distinctive characteristic feature –
spreading of ribs in its dilatable neck. Cannot be
seen in a dead cobra
 Spectacle mark: on the dorsal side of the snake’s
hood
 Length: 6-8 feet
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11. Spectacle shaped mark
Hood
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12.  Also called: Nagraj (H); Raja naagamu(T)
 Colour: Olive green tan or black
 Length: 12 feet
 Has faint, pale yellow cross bands down the length
of the body
 Head: massive and bulky
 Size larger than common cobra with no spectacle
mark on the hood
 Preys chiefly on other snakes
 Most dangerous and feared Indian snake; delivers
large quantity of highly potent venom in single bite
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14.  Also called: Karaith(H); Katla paamu(T)
 Colour: Olive green tan or black
 Length: 1 meter average
 Male is larger than female and has a longer tail
 Colour: dark steely blue black to faded bluish grey
 Belly: creamy white
 Large hexagonal scales running down the spine
 Body shows stripes (not true bands)
 4 infralabial shields; 4th being the largest
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16.  Also called: Ahiraaj saamp(H); bungaru paamu(T)
 Colour: Alternate jet black and yellow cross bands
of equal size measuring about 5 cm
 Body: triangular in cross section
 Marked vertebral ridge consisting of enlarged
hexagonal vertebral scales
 Head: broad and depressed; arrow-head like yellow
markings
 Black mark on neck which is spread to eyes
 Tail: small; ends like a finger-tip
 Length: 1-2 meters
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18.  Found in warm coastal waters
 Colour: black, bluish black, greenish black
 Head: small eyes and prominent nostrils on top of
head and small trabeculated dorsal scales
 Body: Laterally compressed; eel-like appearance
 Tail: paddle like
 Do not have gills and come to surface to breathe
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21.  Poison glands: situated behind the eyes; each side of
the head above the upper jaw
 Fangs: 2 in number
 Curved teeth situated on the maxillary bones and lie
along the jaws
 Covered by flap of mucous membrane
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22.  Most snakes have 6-
12 of these enzymes:
 Adenosine
Triphosphatase
 Agglutinins
 Amino-acid oxidase
 Biological amines –
histamine, serotonin
 Cardiotoxin
 Cholinesterase
 Cytolysin
 Hemorrhagins
 Hyaluronidase
 Hydrolases
 Neurotoxins
 Nucleases
 Lecithinases
 Ophanin
 Ophioxidases
 Peptides and
polypeptides
 Phosphodiesterase
 Proteolytic enzymes
 Protease 22

23.  Epidemiology: 15-20,000 deaths/year
 2 faint impressions with 8mm to 4 cm distance
between them
 Dry bite: When snake bites, venom fails to be
injected.
 Approximately 20% of all snake bites are dry
bites
 Causes: Layers of clothing over bitten area,
superficial bite, sideswipes
 Most snakebites are from non-venomous snakes
because they outnumber venomous snakes
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24.  Fright
 Bite marks: row of small punctured wounds without
fang marks
 Slight pain: subsides in 10-15 min
 Oozing of blood
 Oedema: <2.5cm
 Itching: subsides in 20 mins
 Tingling: in the bitten area
 Lodging of tooth: rarely seen
 Wound heals normally without complications
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25.  Ophitoxemia: poisoning by snake venom
 >50% cases inadequate venom is injected, producing
mild symptoms
 Signs and symptoms depend on:
i. Species and size of snake
ii. Pathogens present in snake venom
iii. Conditions of fangs and venom gland
iv. Nature of the bite: location, number and depth
v. Length of time the snake holds on
vi. Amount of venom injected
 Victim dependent: age of victim, sensitivity to
venom
 Community dependent: first aid and medical care
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26. 1. Fright: hypotension, feeble pulse, RR ,
semi consciousness, cold clammy skin
2. Gas gangrene
3. Tetanus
4. Psychological shock
5. Fang marks: 2 in number
 Distance between the two 8mm to 4 cm
 Lower jaw doesn’t leave any fang marks
 Depth: 1-8mm
 Viper cause deeper bites than elapids(cobras
and kraits).
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27.  Local manifestations: within 6-8 mins
1. Small reddish wheal or bullae develop at the
site of bite
2. Tenderness: radiating burning pain
3. Swelling: minimal/absent
 Systemic: appear after 30 mins
i. Nausea, vomiting
ii. Excessive salivation, headache, vertigo,
paraesthesia, myalgia, irritability
iii. CNS depression
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28. iv. Paralysing effects: first detectable as ptosis
 Blurring of vision, diplopia, strabismus
(involvement of oculomotor N)
 Paralysis of lower limbs, trunk, neck and head
 Dysphonia, dysphagia, absent gag reflex
 After 2hours: complete paralysis
 Respiratory arrest: paralysis of Intercostal
muscles
v. Convulsions and coma
 Cause of death: respiratory failure
 If recovery occurs: skin and cellular tissues
surrounding bite mark undergoes necrosis
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29.  Local manifestations: minimal
1. Scarcely perceptible puncture
marks
2. Mild tenderness, itching,
numbness, paraesthesia
 Systemic:
i. Abdominal pain
ii. Fasciculation
iii. Feeling of drowsiness,
intoxication
iv. Paralysis: develops within 2
hours
v. Urine: shows albumin
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30.  Local manifestations:
1. Swelling: around the bite. Spreads quickly
 Malignant oedema of entire limb
 Pain, paraesthesia, reddening, tenderness
2. Persistent bleeding
3. Regional Lymphadenopathy
4. Blisters: appear within 12 hours. Clear/blood
stained
5. Extensive necrosis: suppuration, sloughing
6. Increased intra-compartmental pressure
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31.  Systemic manifestations: Haematological abnormalities
most characteristic of viper
 Pathophysiology:
 RBC, platelets; Clotting time, bleeding time
 Ecchymosis, petechial haemorrhages, epistaxis,
haematuria, haemoptysis, intravascular haemolysis,
renal failure, retroperitoneal haemorrhages
 CVS: hypotension, tachycardia
 Miscellaneous: Pupils dilated, blurring of vision and
temperature increased
 Cause of death: Haemorrhagic shock
DIC
Fibrin
used up
Defibrination Blood
incoagulable
Primary pathological
fibrinolysis
Microthrombi deposition
used up
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32.  Local manifestations: minimal/absent
 Trismus: common
 Generalised muscle weakness and tenderness
 Thirst, vomiting, seating
 Generalized rhabdomyolysis: Hyperkalaemia
 Polymyositis
 Progressive flaccid paralysis
 Urine dark reddish brown in colour; Renal failure
 Lab tests: Muscle enzymes and plasma K+ increased,
myoglobinemia and myoglobinuria
 Cause of Death: respiratory paralysis/cardiac death
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34.  Identification of snake: if dead snake is
brought by relatives
 Snake venom components: from aspirates,
biopsies, body fluids, wound swabs
 Radio-immunoassay: most sensitive and
specific. Cholinesterase and thromboplastin
are detected
 Enzyme immunoassay: simpler, more widely
used
 Immunological: ELISA
 Urine: venom detectable
 Animal testing
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35.  FIRST AID:
a. Reassure victim
b. Do not tamper with bite wound
c. Immobilization
d. Avoid elevation of bitten part of
body
e. Pressure immobilization:
Sutherland wrap – contraindicated
in viper bites
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36. 1. Close monitoring: vitals, cardiac rhythm, urine
output
2. Symptomatic treatment: fluid resuscitation
3. PAV: poly valent anti snake venom therapy
 Method of preparation: hyper immunising horses
against the venom of ‘big four’ snakes
 Useful when given within 4 hours of bite; doubtful
after 24 hours
 Indications: evidence of systemic manifestation
 Complications:Allergic reactions,blindness,
Serum sickness – fever, chills, myalgia,
renal failure. Develop within 1-2 weeks.
T/t with systemic glucocorticoids
Venom Each Vial
of PAV
Cobra 6 mg
Russel’s Viper 6 mg
Common Krait 4.5 mg
Sawscaled Viper 4.5 mg
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37. 4. Vasopressors
5. Acetyl cholinesterase inhibitors: useful inn
neurotoxic envenomation
 Endrophonium/neostigmine. Pre treat with
atropine
6. Wound care: debridement, dressing and splinting
7. Tetanus immunisation
8. Prophylactic antibiotics: cephalosporins
9. Analgesics: NSAIDs
10. Treatment for muscle compartment syndrome:
fasciotomy
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40.  Common to all venomous snakes:
1. Fangs – 1 or 2 in number
2. Washings from site of bite: show venom
components
3. Internal organs: congested
I. Elapids: Local changes – minimal
 Brain: congested
II. Vipers: Local changes: cellulitis, discolouration and
swelling
 Haemorrhages: prominent, on mucous membranes
into bowel, lungs and almost all other tissues
 Pruritic spots on pericardium
 Kidneys: inflamed, haemorrhagic
III. Sea snakes: Signs of rhabdomyolysis
 Kidney: congested, tubules blocked with myoglobin
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41.  Manner of Death:
 Accidental: most common
 Homicide: by throwing of snake on bed of
sleeping person
 Suicidal: very rare
 Infanticide: homicidal, accidental as it is
excreted in breast milk
 Cattle poison
 Venom as drug of addiction
 Bio warfare
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43.  Predatory arthropods of
class Arachnida
 Scorpions sting rather than
bite
 Colour: light yellow to
black
 Venom: clear and
colourless
 Components: Neurotoxins,
acetylcholinesterase,
cardiotoxins, haemolysins,
hyaluronidase, histamine,
etc.
 Mode of action: opens
neuronal Sodium channels
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44.  Local: lasts 1-2 hrs
 Oedema, erythema, pain, regional
lymphadenopathy
 Systemic: Nausea, vomiting
 Anaphylaxis/allergic reactions
 Paralysis and respiratory depression
 Sympathetic: cardiogenic shock, MI, BP
increases, arrhythmias, pulmonary
oedema
 Parasympathetic: priapism, sweating
 Other: coagulopathy, pancreatitis, stroke
 Fatal period: few hours
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45.  Diagnosis: single punctured wound. Confirmed by
ELISA.
 ECG: shows peaked T-waves
 TREATMENT:
 First aid: immobilization, tourniquet, TT injection
 Supportive care: ice packs, analgesics
 T/t of Hypertension: Prazosin, Nifedipine
 Calcium gluconate for local swelling
 Scorpion venom antiserum
 Systemic Antibiotics
 Muscle relaxants
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46.  Cause of Death: Cardiac failure, pulmonary
oedema
 PM Changes:
 Local: usually a limb(extremities)
 Reddened and oedematous
 One hole in the centre
 Viscera congested
 Lab Analysis:
 Skin, subcutaneous tissue and muscle
surrounding tissue preserved for chemical
analysis
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47.  Emerald green beetle
 Active principle: cantharidin – irritant
 Cantharides: crushed powder of Spanish fly
 Mechanism of Action: potent inhibitor of protein
phosphatases type 1 and 2A
 SIGNS AND SYMPTOMS:
 External: redness, burning pain, blisters
 Ingested: within 2-4 hours
 GI: Burning in mouth, dysarthria, dysphagia
 Blistering of lips and tongue
 Nausea, vomiting, hematemesis
SPANISH FLY
CANTHARIDES
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48.  Intestinal colic, bloody diarrhoea, tenesmus
 Renal: scanty urine, dysuria, haematuria, scanty urine
 Others: priapism, abortion, convulsions and death
 Cause of death: Renal failure
 FATAL DOSE: 10-80 mg FATAL PERIOD: 24-36 hrs
 TREATMENT:
 Pain control: pethidine
 Symptomatic treatment: anti-emetics, IV fluids
 Stomach wash
 Demulcent: milk
 Vasopressor agents: norepinephrine
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49.  Mouth: inflammation and vesication
 Mucosa of GIT: congested, swollen, show ulcerations
 Shiny green particles: sticking to stomach mucosa
 Lungs: oedematous
 Trachea and Bronchi: contained blood stained mucus
 Heart: sub epicardial and sub endocardial
haemorrhages
 Viscera: congested
 MLI:
 Accidental poisoning: used as counter irritant in
herbal medicine
 Criminal Abortion
 Aphrodisiac
 Homicide: rarely 49

50.  Venom claws: forms from a modified 1st appendage
 Venom components: Serotonin, toxin S, proteinases,
cytolysis
 SIGNS AND SYMPTOMS:
 Local: oedema, pain, erythema, lymphadenitis,
paraesthesia
 Skin necrosis may occur. Heals spontaneously
 Systemic: anxiety, dizziness, palpitations, nausea
 TREATMENT:
 Symptomatic treatment: TT injection, analgesics
 Application of heat
 Antihistamines
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51.  Leaves the stinger in patient’s skin after the bee has
flown away
 Venom: apitoxin-bitter colourless liquid
 0.1 mg injected from stinger
 Composition: apamin, Phospholipase A2,
hyaluronidase, histamine, dopamine
 SIGNS AND SYMPTOMS:
 Local: pain, erythema, 1 cm oedema surrounding
sting
 Generalized: pruritus, urticaria, angioedema,
hypotension
 Diagnosis: Venom specific IgE antibodies – skin prick
test, Radioallegrosorbent test (RAST)
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52.  Removal of stinger
 Local reactions: ice packs, pain killers,
antihistamines
 For allergic reactions: inhaled β2 agonists,
adrenaline
 MLI:
 Sudden death: by choking due to anaphylaxis
 Occupational accidents
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53.  WASP: Doesn’t leave the stinger in patient’s skin
 Composition: Antigen 5, Phospholipase A1,
Phospholipase A2, hyaluronidase, pronectin,
neurotoxins
 SIGNS AND SYMPTOMS:
 Similar to bee sting
 FIRE ANT:
 Composition: Antigen 5, Phospholipase A1,
hyaluronidase
 SIGNS AND SYMPTOMS: burning pain, small wheal and
small pustule
 HOUSE ANT: secrete formic acid by glands situated in
the tail.
 Produces pain irritation, swelling 53

54. HONEY BEE WASP
FIRE ANT HOUSE ANTS
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55.  Arthropods with fangs that inject venom
 Types of venom: neurotoxic and cytotoxic
 SIGNS AND SYMPTOMS:
 Neurotoxic venom: Pain, radiating along affected
limb
 Hypertension, agitation, paraesthesia, fasciculation,
cardiac effects
 Contorted grimacing sweating facial appearance –
facies latrodectismica
 Cytotoxic venom: Cutaneous necrosis
 TREATMENT:
 First Aid: immobilisation, TT injection
 Symptomatic: analgesics, antihistamines, antibiotics
 Dapsone and Colchicine: to reduce necrosis
 Antivenom therapy 55

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