Snake bite treatment revisited

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fujita yuji

Joined
Jul 12, 2008
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Hi, forumates.
I've found an article of new treatment for snakebite.

http://news.sciencemag.org/sciencenow/2011/06/when-the-snake-bites-try-ointmen.html

It says applying nitroglycerin as an ointment makes lymphatic vessels to clench and delays spreading venom.
The article also says It is not the final solution to the snake venom, just to earn some hours or minutes to have antyvenom .

Not sure how to carry nitro safely though. Maybe hazardous than snakes when detonated :D
 
I'm not sure. While nitroglycerin may contract lymphatic vessels, it dilates blood vessels which is why it's used for angina, chest pain resulting from inadequate blood supply to the heart.

The common product is a 2% ointment and, because of its low concentration, is not explosive.
 
Yes, but based on my last perusal of the literature, most of the time venom toxins will find themselves in the lymphatic system before entering the bloodstream (the article linked mentions the same). IMO, the more valid question, or at least more pertinent for those of us here in the US, is the one raised at the end of the article: would use of an NO donor be advised with cytotoxic envenomation vs. neurotoxic. For example, I'm no expert, but it would seem to me that if one were bitten by a rattlesnake here in the states, use of this ointment would be contraindicated as it would probably keep the venom concentrated and localized.

ETA: Thanks for the interesting article Fujita! Going to have to try and get access to the full article later. Fujita, I was just looking at Japanese venomous snakes out of curiosity, and the Mamushi venmo is both both hemolytic and neurotoxic...yikes.
 
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fujita yuji said:
Hi, forumates.
I've found an article of new treatment for snakebite.

http://news.sciencemag.org/sciencenow/2011/06/when-the-snake-bites-try-ointmen.html

It says applying nitroglycerin as an ointment makes lymphatic vessels to clench and delays spreading venom.
The article also says It is not the final solution to the snake venom, just to earn some hours or minutes to have antivenom .

Not sure how to carry nitro safely though. Maybe hazardous than snakes when detonated :D
Click to expand...

Interesting how different media have different focuses. Our media http://www.abc.net.au/news/stories/2011/06/27/3254133.htm focuses on the active ingredient, ie Nitric Oxide.

When a decent wet bite from a Eastern Brown snake can stop a heart in 10 minutes, buying an extra 40 minutes can make a real difference. :thumbup:

But not all areas of our world have snakes with the same types of venom.

Just goes to show that a "condom approach to life outdoors" (i.e. one size fits all) is rarely usefull.

Whilst the delay in delivery of the venom from the lymphatic system is a definete advantage for neurotoxic venom, as has already been mentioned, this could be a potential disadvantage for cytotoxic venom that is found in the majority of Nth American snakes.




Kind regards
Mick
 
Gollnick said:
The common product is a 2% ointment and, because of its low concentration, is not explosive.
Click to expand...

Thanks, Gollnick.
Now I'm feeling releafed.

HikingMano said:
ETA: Thanks for the interesting article Fujita! Going to have to try and get access to the full article later. Fujita, I was just looking at Japanese venomous snakes out of curiosity, and the Mamushi venmo is both both hemolytic and neurotoxic...yikes.
Click to expand...

Glad you found this interesting, HikingMano.
I've go no access to the full article, nor I'm not very familiar with
biological toxic substances and treatment.
And you mentioned about Mamushi, the only major venomous snake in the mainland.
Actually they are relatively harmless silent member of the bush, controlling
rodents population.

SouthernCross, I must agree with you about what you said.
One size never fits all.

Does it make thing worse if cytotoxic venom is kept local by clenching
of vessels ? Does it mean spreading venom makes thing better ?
 
Oh no, I meant I wanted to try and get access to the Nature Medicine article later. :thumbup:

Good to know Mamushi are relatively harmless to humans :) Wikipedia claims
Every year, 2000–3000 people in Japan are bitten by mamushi, bite victims typically require one week of treatment in hospital, severe bites require intensive care, and approximately 10 victims die.
Click to expand...
based on two cited journal articles. In contrast, Wikipedia claimed this about our own rattlesnakes
Between 7,000 and 8,000 people are estimated to have been bitten by venomous snakes in the United States each year, and about five of those die.
Click to expand...
The article cited quotes an estimate from a 2002 New England Journal of Medicine study. So on face value and without any actual digging, the Mamushi seemed more dangerous than our own rattlesnakes.

I would think keeping cytotoxic venom concentrated and local would do more tissue damage, but again, I'm no herpetologist. Perhaps you're better off with local tissue damage rather than any systemic effects that may arise from allowing the venom to spread. But my guess is the thought of venom dilution might be behind current recommendations of removing restrictive clothing and jewelry to allow for swelling (as first aid for US pit viper envenomation).
 
Nitroglycerin ointment is actually not commonly used; it's messy and hard to control dosage. Most nitroglycerin patients -- and this is a common drug -- take pills. Nitroglycerin is quickly and readily absorbed in pill form and fast-acting. Of course, pills are easier to carry and use than ointment any day. I wonder if oral pills would be as effective for snake bites as the topical ointment is? (The pills are also, by the way, of such a low concentration as to pose no explosion risk.)
 
Gollnick, do they use sublingual Nitro sprays in the US? I know we use them here, and when I was a medic, we kept the sprays in our Thomas packs, as once the bottles of tabs are opened, they have to be discarded in something like 60 days, whereas the sprays remain viable until the expiry date.
G
 
I'm not a doctor or pharmacist. I have not seen the spray used, but a quick google shows that it is available. Sublingual means "under the tongue". Nitroglycerin pills are not swallowed, they are placed under the tongue and dissolve and the nitroglycerin is readily absorbed through the lining of the mouth which is an area of the body especially receptive to this sort of entry (same way nicotine enters the body when chewing tobacco). The spray apparently is typically used the same way. BUT, I now wonder if the spray could be applied to the skin immediately at the bite site for a more local effect? The would be similar to the application of the ointment directly to the bite site.

The ointment -- aside from being bulky to carry and messy to use -- also suffers a short shelf life.

So, this spray idea may be a great way to go.

I wonder how we can get these questions and ideas to the researchers?
 
Mamushi sometimes comes into a house while chasing rodents, especially at night.
Then the snake finds a nice warm place with moderate humidity, which is of course an occupied bed.
The person rolls over and the snake mistakes it as offended.
 
Gollnick said:
BUT, I now wonder if the spray could be applied to the skin immediately at the bite site for a more local effect? The would be similar to the application of the ointment directly to the bite site.

The ointment -- aside from being bulky to carry and messy to use -- also suffers a short shelf life.
Click to expand...
And I think the sprays are less effected by heat too.



Great minds think alike. Though normally, I tend to be more of a radical;)
 
HikingMano said:
Fujita, I was just looking at Japanese venomous snakes out of curiosity, and the Mamushi venmo is both both hemolytic and neurotoxic...yikes.
Click to expand...
All venomous snakes share venom types. Rattlesnake venom does have some neurotoxins, it is just a very small amount. Subspecies such as the Mojave green more so than others. Primarily neurotoxic snakes tend to have more hemotoxins than hemotoxic snakes have neurotoxins. THe hemolytic properties allow the neurotoxins to travel through the body of the victim much more quickly.
 
fujita yuji said:
.....Does it make thing worse if cytotoxic venom is kept local by clenching
of vessels ? Does it mean spreading venom makes thing better ?
Click to expand...

Since our snakes are all elapids rather than pit vipers, I'll defer to those with more experience than me.

Although I do remember a post from several years ago on another forum, from a younger Joe Flowers (back in the day before he made the big time & achieved moderator status here.) :D

IIRC, he mentioned the advice of a professor he knew that was recommending allowing cytotoxic venom to be diluted through circulation rather than restricting the dilution of the venom by compression bandages (which slows down the spread of the venom through the limph system to the blood stream).

Maybe Joe can step in an add his opinion when he reads this. :thumbup:

BTW this is not something that is recommended for treating a bite from an Australian snake.




Kind regards
Mick
 
I am thinking about heading back to "Rattlesnake den" primitive camping area and will use the best snake bite treatment in the world. Avoiding getting tagged in the first place! I will try to look first before placing my hands and feet. If I run into a rattlesnake or copperhead I may take photos but will avoid contact. I bet most people get hit when attempting to kill or handle them. If I fail at all of the above despite the fact the drive to the trail head was probably statically far more dangerous I won’t be using a stupid snake bite kit as that will just do more damage than good. I don't know anything about nitroglycerin however.
 
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What I learned from Maynard Cox... Founder and Director of the World Wide Poison Bite Information Center; in addition he wrote the manual, Protocol For Emergency Room Procedures and Hospital Management of Snakebites.

You get bit by a pit viper (here in the states), treat for shock, go the hospital and get anti-venom.

Face is pale, raise the tail. Face is red, raise the head.

DON'T cut and suck
DON'T use a tourniquet
DON'T apply ice

The molecular weight of the venom is such that it is not going anywhere unless you get hit in a major artery which is not likely. Treating for anything other than shock before you get to the hospital will likely cause additional tissue damage.

From the link above...

""According to Cox, there are different factors that weigh into those most at risk from snakebites: immune systems, where one is bitten, how much venom is injected and the condition of the bitten individual. U.S. snakebite statistics in the last 30 years show approximately 48,000 yearly are bitten by snakes, about 8,000 are poisonous and only about 10 die yearly due to improper care. While the mortality statistic is comforting, Cox warns that proper treatment is the key.""
 
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