Neostigmine in the treatment of snake accidents caused by Micrurus frontalis: report of two cases

Vital Brazil, Oswaldo; Vieira, Ronan José

doi:10.1590/S0036-46651996000100012

Abstracts

Antivenom in order to be effective in the treatment of coral snake accidents must be injected very soon after the bite owing to the rapid rate of absorption of the venom neurotoxins. As this is not always possible, other forms of treatment besides serotherapy must be employed to avoid asphyxia and death. Neostigmine and artificial respiration are used for this purpose. Neostigmine restores neuromuscular transmission if the venom-induced blockade results from a reversible interaction of its neurotoxins with the end-plate receptors. This is the mechanism of the neuromuscular blockade produced by the venom of M. frontalis snakes from centereastern and southern Brazil, and Argentine. Neostigmine is able, therefore, to antagonize the blockade, and has been shown to be very effective in the treatment of the experimental envenomation of dogs and monkeys. In the present communication, two cases of M. frontalis accidents treated with antivenom and neostigmine are reported. In both, neostigmine was successful in producing regression of the paralysis, confirming the effectiveness shown in the treatment of the poisoning induced in animals by M. frontalis venom.

Coral snake; Venom; Neostigmine; Anticholinesterase drugs; Envenomation

O soro antipeçonhento específico para ser eficaz no tratamento dos acidentes causados pelas cobras corais deve ser administrado logo após a mordedura, uma vez que as neurotoxinas da peçonha são absorvidas muito rapidamente. Como isto não é sempre possível, outras formas de tratamento, além do soroterápico, devem ser empregadas para evitar a asfixia e morte do paciente. A administração da neostigmina e a respiração artificial são utilizadas com esse objetivo. A neostigmina restabelece a transmissão neuromuscular se o efeito da peçonha resultar de interação reversível de suas neurotoxinas com os receptores da placa terminal. É esse o mecanismo da ação das neurotoxinas da peçonha de M. frontalis de serpentes do centroeste e sul do Brasil, e da Argentina. Em conseqüência a neostigmina antagoniza o bloqueio neuromuscular produzido pela peçonha dessas serpentes e é muito eficaz no tratamento do envenenamento experimental de cães e símios. Na presente comunicação relatamos dois acidentes causados por M. frontalis, tratados com a administração do soro específico e da neostigmina. Nos dois pacientes a administração da neostigmina produziu regressão completa dos fenômenos de paralisia, confirmando sua eficiência demonstrada no tratamento do envenenamento experimental de animais

CASE REPORT

Neostigmine in the treatment of snake accidents caused by Micrurus frontalis: report of two cases¹ 1 Work presented at the 1 st International Congress on Envenomations and Their Treatments held in Paris at the Scientific Information Center of Pasteur Institute, June 7-9, 1995.

Neostigmina no tratamento dos acidentes ofídicos causados por Micrucurus frontalis: relato de dois casos

Oswaldo Vital Brazil^I; Ronan José Vieira^II

^IDepartment of Pharmacology. Faculty of Medical Sciences. State University of Campinas (Unicamp)

^IIDepartment of Clinical Medicine. Faculty of Medical Sciences. State University of Campinas (Unicamp)

^{Correspondence to} Correspondence to: Prof. Oswaldo Vital Brazil Department of Pharmacology. Faculty of Medical Sciences. State University of Campinas (Unicamp) P. O. Box 6111 13084-100 Campinas, SP., Brazil Tel. (0192) 39-7482. Fax (0192) 39-2968

SUMMARY

Antivenom in order to be effective in the treatment of coral snake accidents must be injected very soon after the bite owing to the rapid rate of absorption of the venom neurotoxins. As this is not always possible, other forms of treatment besides serotherapy must be employed to avoid asphyxia and death. Neostigmine and artificial respiration are used for this purpose. Neostigmine restores neuromuscular transmission if the venom-induced blockade results from a reversible interaction of its neurotoxins with the end-plate receptors. This is the mechanism of the neuromuscular blockade produced by the venom of M. frontalis snakes from centereastern and southern Brazil, and Argentine. Neostigmine is able, therefore, to antagonize the blockade, and has been shown to be very effective in the treatment of the experimental envenomation of dogs and monkeys. In the present communication, two cases of M. frontalis accidents treated with antivenom and neostigmine are reported. In both, neostigmine was successful in producing regression of the paralysis, confirming the effectiveness shown in the treatment of the poisoning induced in animals by M. frontalis venom.

Keywords: Coral snake; Venom; Neostigmine; Anticholinesterase drugs; Envenomation.

RESUMO

O soro antipeçonhento específico para ser eficaz no tratamento dos acidentes causados pelas cobras corais deve ser administrado logo após a mordedura, uma vez que as neurotoxinas da peçonha são absorvidas muito rapidamente. Como isto não é sempre possível, outras formas de tratamento, além do soroterápico, devem ser empregadas para evitar a asfixia e morte do paciente. A administração da neostigmina e a respiração artificial são utilizadas com esse objetivo. A neostigmina restabelece a transmissão neuromuscular se o efeito da peçonha resultar de interação reversível de suas neurotoxinas com os receptores da placa terminal. É esse o mecanismo da ação das neurotoxinas da peçonha de M. frontalis de serpentes do centroeste e sul do Brasil, e da Argentina. Em conseqüência a neostigmina antagoniza o bloqueio neuromuscular produzido pela peçonha dessas serpentes e é muito eficaz no tratamento do envenenamento experimental de cães e símios. Na presente comunicação relatamos dois acidentes causados por M. frontalis, tratados com a administração do soro específico e da neostigmina. Nos dois pacientes a administração da neostigmina produziu regressão completa dos fenômenos de paralisia, confirmando sua eficiência demonstrada no tratamento do envenenamento experimental de animais.

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Recebido para publicação em 08/11/1995.

Aceito para publicação em 19/12/1995.

1. BANERJEE, R.N.; SAHNI, A.L. & CHACKO, K.A. - Neostigmine in the treatment of Elapidae bites. In: OKSAKA, A. et al., ed. Animal plants and microbial toxins.New York, Plenum Press, 1974. p. 475-481.
2. BRAZIL, V. - La défense contre l'ophidisme. 2. ed. Săo Paulo, Pocai Weiss, 1914.
3. CAMPBELL, C.H. - Symptomatology, pathology and treatment of the bites of elapid snake. In: LEE, C.Y., ed. Snake venoms. Berlin, Spring-Verlag, 1979. p. 898-921.
4. COELHO, L.K.; SILVA, E.; ESPOSITO, C. et al. - Clinical features and treatment of Elapidae bites: report of three cases. Hum. exp. Toxicol., 11: 135-137, 1992.
5. CURIE, B.; FITMAURICE, M. & OAKLEY, J. - Resolution of neurotoxicity with anticholinesterase therapy in death-adder envenenomation. Med. J. Aust., 148: 522-525, 1988.
6. GUTIÉRREZ, J.M.; LOMONTE, B.; PORTILLA, E. et al. - Local effects induced by coral snake venoms: evidence of myonecrosis after experimental inoculations of venoms from five species. Toxicon, 21: 777-783, 1983.
7. KELLAWAY, C.H.; CHERRY, R.C. & WILLIANS, F.E. - The peripheral action of the Australian snake venoms. 2. The curari-like action in animals. Aust. J. exp. Biol. med. Sci., 10: 181-194, 1932.
8. KUMAR, S. & USGAONKAR, R.S. - Myasthenia gravis like picture resulting from snake bite. J. Indian med. Ass., 50: 428-429, 1968.
9. LEE, Y.C. & PENG, M.T. - An analysis of the respiratory failure produced by elapid venoms. Arch. int. Pharmacodyn., 133: 180-192, 1961.
10. NAPHADE, R.W. & SHETTI, R.N. - Use of neostigmine after snake bite. Brit. J. Anaesth., 49: 1065-1068, 1977.
11. PANDEY, A.K.; SINGH, A.N. & SINHA, B.N. - Neostigmine in the neuroparalytic effects of snake bite. J. Indian med. Ass., 73: 86-88, 1979.
12. PAWAR, D.K. & SINGH, H. - Elapid snake bite. Brit. J. Anaesth., 59: 385-387, 1987.
13. PELLEGRINI FILHO, A. & VITAL BRAZIL, O. - Origem da paralisia respiratória determinada pela peçonha de Micrurus frontalis. Cięnc. e Cult., 28: 199-202, 1976.
14. RIBEIRO, L.A. - Estudo epidemiológico de acidentes por serpentes peçonhentas no Estado de Săo Paulo, atendidos no Hospital Vital Brazil. 1988. Săo Paulo, 1991. (Tese de Mestrado - Faculdade de Saúde Pública da Universidade de Săo Paulo).
15. ROSENFELD, G. - Symptomatology, pathology and treatment of snake bites in South America. In: BÜCHERL, W. & BUCKLEY, E.E., ed. Venomous animals and their venoms. New York, Academic Press, 1971. p. 345-348.
16. SHARON, R. - Neostigmine in the management of snake bite. J. Indian med. Ass., 78: 61-63, 1982.
17. VITAL BRAZIL, O. - Coral snake venoms: mode of action and pathophysiology of experimental envenomation. Rev. Inst. Med. trop. S. Paulo, 29: 119-126, 1987.
18. VITAL BRAZIL, O. - Sinais e sintomas neurotóxicos do envenenamento ofídico: açăo central ou periférica da peçonha das serpentes? Rev. Assoc. méd. bras., 36: 63-65, 1990.
19. VITAL BRAZIL, O. & BARRIO, A. - Acción curarizante de las ponzońas de Elapidae. II. Efectos de algunos antagonistas del curare. Prensa méd. argent., 37: 1313-1318, 1950.
20. VITAL BRAZIL, O. & FONTANA, M.D. - Açőes pré-juncionais e pós-juncionais da peçonha da cobra coral Micrurus corallinus na junçăo neuromuscular. Mem. Inst. Butantan, 47/48: 13-26, 1983/84.
21. VITAL BRAZIL, O. & PELLEGRINI FILHO, A. - Antagonistic effect produced by neostigmine upon the paralysis caused by Micrurus frontalis venom (Film). In: ROSENBERG, P., ed. Toxins, animal, plant and microbial. Oxford, Pergamon Press, 1978. p. 437-438.
22. VITAL BRAZIL, O.; EUGĘNIO, A.G.B. & LASZLO, G.M. - Origem da paralisia respiratória causada pela crotoxina. Cięnc. e Cult., 25: 1165-1169, 1973.
23. VITAL BRAZIL, O.; FONTANA, M.D. & PELLEGRINI FILHO, A. - Physiologie et thérapeutique de l'envenomation causée par le venin de Micrurus frontalis. Mem. Inst. Butantan, 40/41: 221-240, 1976/77.
24. WARREL, D.; LOOAREESUWAN, S.; WHITE, N.J. et al. - Severe neurotoxic envenoming by the Malayn Krait Bungarus candidus (Linneus): response to antivenom and anticholinesterase. Brit. med. J., 286: 678-680, 1983.
25. WATT, G., THEAKSTON, R.D.G.; CURTIS, G. et al. - Positive response to edrophonium in patients with neurotoxic envenoming by cobras (Naja naja philippensis). New Engl. J. Med., 315: 143-148, 1986.
26. WEISS, R. & McISAAC, R. - Cardiovascular and muscle effects from coral snake Micrurus fulvius. Toxicon, 2: 219-228, 1971.

Correspondence to:

Prof. Oswaldo Vital Brazil

Department of Pharmacology. Faculty of Medical Sciences. State University of Campinas (Unicamp)

P. O. Box 6111

13084-100 Campinas, SP., Brazil

Tel. (0192) 39-7482. Fax (0192) 39-2968

1

Work presented at the 1 st International Congress on Envenomations and Their Treatments held in Paris at the Scientific Information Center of Pasteur Institute, June 7-9, 1995.

Publication Dates

Publication in this collection
22 Sept 2006
Date of issue
Feb 1996

History

Accepted
19 Dec 1995
Received
08 Nov 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BANERJEE, R.N.; SAHNI, A.L. & CHACKO, K.A. - Neostigmine in the treatment of Elapidae bites. In: OKSAKA, A. et al., ed. Animal plants and microbial toxins.New York, Plenum Press, 1974. p. 475-481.

[2] 2. BRAZIL, V. - La défense contre l'ophidisme. 2. ed. Săo Paulo, Pocai Weiss, 1914.

[3] 3. CAMPBELL, C.H. - Symptomatology, pathology and treatment of the bites of elapid snake. In: LEE, C.Y., ed. Snake venoms. Berlin, Spring-Verlag, 1979. p. 898-921.

[4] 4. COELHO, L.K.; SILVA, E.; ESPOSITO, C. et al. - Clinical features and treatment of Elapidae bites: report of three cases. Hum. exp. Toxicol., 11: 135-137, 1992.

[5] 5. CURIE, B.; FITMAURICE, M. & OAKLEY, J. - Resolution of neurotoxicity with anticholinesterase therapy in death-adder envenenomation. Med. J. Aust., 148: 522-525, 1988.

[6] 6. GUTIÉRREZ, J.M.; LOMONTE, B.; PORTILLA, E. et al. - Local effects induced by coral snake venoms: evidence of myonecrosis after experimental inoculations of venoms from five species. Toxicon, 21: 777-783, 1983.

[7] 7. KELLAWAY, C.H.; CHERRY, R.C. & WILLIANS, F.E. - The peripheral action of the Australian snake venoms. 2. The curari-like action in animals. Aust. J. exp. Biol. med. Sci., 10: 181-194, 1932.

[8] 8. KUMAR, S. & USGAONKAR, R.S. - Myasthenia gravis like picture resulting from snake bite. J. Indian med. Ass., 50: 428-429, 1968.

[9] 9. LEE, Y.C. & PENG, M.T. - An analysis of the respiratory failure produced by elapid venoms. Arch. int. Pharmacodyn., 133: 180-192, 1961.

[10] 10. NAPHADE, R.W. & SHETTI, R.N. - Use of neostigmine after snake bite. Brit. J. Anaesth., 49: 1065-1068, 1977.

[11] 11. PANDEY, A.K.; SINGH, A.N. & SINHA, B.N. - Neostigmine in the neuroparalytic effects of snake bite. J. Indian med. Ass., 73: 86-88, 1979.

[12] 12. PAWAR, D.K. & SINGH, H. - Elapid snake bite. Brit. J. Anaesth., 59: 385-387, 1987.

[13] 13. PELLEGRINI FILHO, A. & VITAL BRAZIL, O. - Origem da paralisia respiratória determinada pela peçonha de Micrurus frontalis. Cięnc. e Cult., 28: 199-202, 1976.

[14] 14. RIBEIRO, L.A. - Estudo epidemiológico de acidentes por serpentes peçonhentas no Estado de Săo Paulo, atendidos no Hospital Vital Brazil. 1988. Săo Paulo, 1991. (Tese de Mestrado - Faculdade de Saúde Pública da Universidade de Săo Paulo).

[15] 15. ROSENFELD, G. - Symptomatology, pathology and treatment of snake bites in South America. In: BÜCHERL, W. & BUCKLEY, E.E., ed. Venomous animals and their venoms. New York, Academic Press, 1971. p. 345-348.

[16] 16. SHARON, R. - Neostigmine in the management of snake bite. J. Indian med. Ass., 78: 61-63, 1982.

[17] 17. VITAL BRAZIL, O. - Coral snake venoms: mode of action and pathophysiology of experimental envenomation. Rev. Inst. Med. trop. S. Paulo, 29: 119-126, 1987.

[18] 18. VITAL BRAZIL, O. - Sinais e sintomas neurotóxicos do envenenamento ofídico: açăo central ou periférica da peçonha das serpentes? Rev. Assoc. méd. bras., 36: 63-65, 1990.

[19] 19. VITAL BRAZIL, O. & BARRIO, A. - Acción curarizante de las ponzońas de Elapidae. II. Efectos de algunos antagonistas del curare. Prensa méd. argent., 37: 1313-1318, 1950.

[20] 20. VITAL BRAZIL, O. & FONTANA, M.D. - Açőes pré-juncionais e pós-juncionais da peçonha da cobra coral Micrurus corallinus na junçăo neuromuscular. Mem. Inst. Butantan, 47/48: 13-26, 1983/84.

[21] 21. VITAL BRAZIL, O. & PELLEGRINI FILHO, A. - Antagonistic effect produced by neostigmine upon the paralysis caused by Micrurus frontalis venom (Film). In: ROSENBERG, P., ed. Toxins, animal, plant and microbial. Oxford, Pergamon Press, 1978. p. 437-438.

[22] 22. VITAL BRAZIL, O.; EUGĘNIO, A.G.B. & LASZLO, G.M. - Origem da paralisia respiratória causada pela crotoxina. Cięnc. e Cult., 25: 1165-1169, 1973.

[23] 23. VITAL BRAZIL, O.; FONTANA, M.D. & PELLEGRINI FILHO, A. - Physiologie et thérapeutique de l'envenomation causée par le venin de Micrurus frontalis. Mem. Inst. Butantan, 40/41: 221-240, 1976/77.

[24] 24. WARREL, D.; LOOAREESUWAN, S.; WHITE, N.J. et al. - Severe neurotoxic envenoming by the Malayn Krait Bungarus candidus (Linneus): response to antivenom and anticholinesterase. Brit. med. J., 286: 678-680, 1983.

[25] 25. WATT, G., THEAKSTON, R.D.G.; CURTIS, G. et al. - Positive response to edrophonium in patients with neurotoxic envenoming by cobras (Naja naja philippensis). New Engl. J. Med., 315: 143-148, 1986.

[26] 26. WEISS, R. & McISAAC, R. - Cardiovascular and muscle effects from coral snake Micrurus fulvius. Toxicon, 2: 219-228, 1971.

Brasil

Brasil

Neostigmine in the treatment of snake accidents caused by Micrurus frontalis: report of two cases

Neostigmina no tratamento dos acidentes ofídicos causados por Micrucurus frontalis: relato de dois casos

Abstracts

Publication Dates

History