QJM Advance Access originally published online on January 24, 2006
QJM 2006 99(2):109-115; doi:10.1093/qjmed/hcl007
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Collett's snake (Pseudechis colletti) envenoming in snake handlers
From the 1Tropical Toxinology Unit, Menzies School of Health Research, Charles Darwin University, Darwin, 2NSW Poison Information Centre, the Children's Hospital at Westmead, Sydney, 3Intensive Care Unit and 5Emergency Department, Townsville Hospital, Townsville, 4Westmead Hospital, Sydney, 6University of Western Australia, Perth, 7Faculty of Health Sciences, University of Adelaide and 8Department of Toxinology, Women's & Children's Hospital, North Adelaide, Australia
Address correspondence to Dr G.K. Isbister, Department of Clinical Toxicology, Newcastle Mater Hospital, Edith St, Waratah NSW 2298, Australia. email: gsbite{at}ferntree.com
Received 26 September 2005 and in revised form 3 December 2005
Background: Collett's snake (Pseudechis colletti) is a member of the black snake genus and occurs in a warm temperate to sub-tropical region of central Queensland, Australia. There are no reports of bites occurring in the wild, and bites were previously thought to cause only minor effects. They are a popular snake among zoos and exotic snake keepers.
Aim: To investigate the clinical effects of severe envenoming by Collett's snake, and possible treatment options.
Design: Case series.
Methods: Clinical and laboratory features are described for six bites, all in snake handlers.
Results: All six bites were from captive snakes, resulting in severe envenoming in four. Two patients were treated early with black snake antivenom, and only developed an anticoagulant coagulopathy and mild myolysis. Two developed anticoagulant coagulopathy and severe rhabdomyolysis associated with acute renal failure, requiring haemodialysis; both received antivenom >10 h after the bite, and initially received minimal fluid replacement. Other effects included thrombocytopenia, non-immune haemolytic anaemia and a marked leukocytosis.
Discussion: Collett's snake envenoming is characterized by early generalized systemic effects (nausea, vomiting, abdominal pain, diarrhoea and headache) and an anticoagulant coagulopathy, followed in some cases by rhabdomyolysis and acute renal failure in untreated patients within 24 h. Early initiation of fluid therapy and treatment with black snake antivenom should be undertaken in all envenomed patients.