First time ever treatment for Snouted cobra bite

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Re: First time ever treatment for Snouted cobra bite

Postby Dendroaspis_bastian » Fri Dec 30, 2011 7:15 pm

Well, I've had some hands on experience with venomous snakes, but I mostly do the work behind the scenes of analyzing venoms which come from snakes milked in zoos, reptile parks, and various other private and public institutions. I know how the venom of these snakes works and I wasn't saying anything to anyone here. I was addressing yoson10 and his claims of "paralysis after 10 minutes". That just doesn't happen in general. It might if the hit is IV, but otherwise no. He will never be able to materialize paralysis from any cobra bite (non-IV) in 10 minutes. 30 minutes, yes. 10 minutes, never.

I studied clinical laboratory science, with strong emphasis on toxicology. I worked for years in a microbio lab, but now I'm working in a clinical chemistry lab (toxicology).
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Re: First time ever treatment for Snouted cobra bite

Postby WW » Fri Dec 30, 2011 8:21 pm

I don't have a PDF of the Watt et al article at hand, but this is a summary of the Naja philippinensis bite literature from Warrell (1995) CLINICAL TOXICOLOGY OF SNAKEBITE IN ASIA. In Meier & White, eds., Clinical toxicology of animal venoms and poisons. CRC Press, Boca Raton.

p. 544

"e. Philippine cobra (N. philippinensis)
Cobras are responsible for about half of the snakebites in the Philippines39. Watt and his
colleagues studied snakebites in the central rice-growing area of Luzon Island north of Manila where
only one species of cobra occurs (N. philippinensis) and is responsible for almost all cases of
envenoming. Of 39 patients bitten by cobras, 38 developed neurotoxicity. The first symptom, occurring
as early as three minutes or as late as 24 hours after the bite (median 1 hour), was usually ptosis
(87%) or slurred speech, dysphonia or breathlessness in the remainder68. Respiratory paralysis
occurred within 10 minutes of the bite in one case and three patients became apnoeic within 30
minutes
. Thirty-six per cent of patients developed no local swelling, including six with respiratory
muscle paralysis. Only 8% of patients developed local necrosis. These clinical findings are consistent
with animal studies in which N. philippinensis venom was found to be more lethal and less necrotic
than other Naja venoms."
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Re: First time ever treatment for Snouted cobra bite

Postby Bushviper » Sat Dec 31, 2011 11:44 am

You say "N. atra (it is island bound in Taiwan)" to the person who actually re-assigned all the Asian Naja species when they were split from Naja naja when in actual fact it occurs in southeastern China (including the provinces of Hainan, Sichuan, Fujian, Guangdong, Guangxi, Guizhou, Hunan, Hubei, and Zhejiang), Hong Kong, northern Laos, northern Vietnam, and Taiwan.

In Hong Kong it is the most common venomous snake bite although the effects of the venom differ with the ones found on Taiwan. In Hong Kong it is predominantly cytotoxic and in Taiwan is is far more neurotoxic. Being a spitting snake (although not very effective) the cytotoxins would make more sense. Over a five year period in Hong Kong 18 Naja atra victims were admitted to hospital and not a single fatality was recorded. I would not class this as "more venomous and often more dangerous" than Naja naja, Naja kaouthia and O. hanna.

Just remember that there are possibly only two or three "institutions or snake parks" in South Africa that could identify the various Asian cobras correctly and still supply you with venom from species that have not been interbred or misidentified. Where was this research published and why was the venom extracted?
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Re: First time ever treatment for Snouted cobra bite

Postby yoson10 » Sun Jan 01, 2012 5:16 am

Dendroaspis_bastian wrote:

Are you serious? Show me an actual case of this happening? It certainly isn't the case with Naja naja or Naja kaouthia - as their venoms are both of very high molecular weight, meaning for an elapid, the venom is slow to act. The case is seen across just about all asiatic cobras - - Naja sputatrix and Naja philippinensis carry high molecular weight venom proteins.



Yes I am completely...I can post numerous examples of it happening within 30 minutes for Naja naja...Only problem is it will take a bit of time to find as I had to wipe my entire computer after the lovely "Alureon H" ran wild on my machine. Cobra venoms are very fast acting.

I don't have any experience with Kaouthia but based on the studies I have read they seem a good deal less virulent than Naja naja.

Dendroaspis_bastian wrote:I think N. nivea has the lowest molecular weight venom proteins of any cobra, making its venom the most rapid-acting of any cobras.


Have no idea about that as I don't know much about African Cobras...But considering you just blatantly challenged one of my claims that I KNOW to be true I'm not convinced of your credibility.

Dendroaspis_bastian wrote:Kraits and australian brown snakes, though more venomous than any cobra, also have very high molecular weight venoms (which is why death may be prolonged for hours, even days in the case of some krait species).



There is no such thing as "more venomous"...That is dopey talk for 5 years olds who want to brag about how badass certain snakes are...Since ALL animals react differently to different venoms there is no way for a "most venomous" or "more venomous" claim to ever accurately be made...Unless you tested it on all mammals/reptiles/amphibians etc and then you found that Krait and Eastern Brown venom was more venomous to a greater number of animals than any cobra venom...The mice test is moronic on so many levels

As for humans...While this is obviously a very LIBERAL estimate...and just based on my interpretations...It seems that Kraits are a good deal bit more venomous than Asian Cobras...I think the Eastern Brown like most Australian snakes are quite overrated but I have only seen a few bite studies


Dendroaspis_bastian wrote:Dendrotoxins are the toxins with the lowest molecular weight (low mass proteins and peptides), making mamba species' venom the most rapid acting. Cases of fully grown adult humans dying within 20 minutes of black mamba bites have been documented, never has there been such documentation for any cobra. Not even for O. hannah.



Yes there has....For both regular and king cobras.

Dendroaspis_bastian wrote:
I can assure you that you will never ever be able to materialize a case where any asiatic cobra "paralyzing diaphragms in 10 minutes". That's just BS. As a holder of a degree in clinical laboratory science, I just laugh when I see that considering the fact that all the proteins (the lethal part of venoms) I've worked with from most alpha-neurotoxins (both long and short proteins) are of high molecular mass.


Give me about 10 minutes
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Re: First time ever treatment for Snouted cobra bite

Postby yoson10 » Sun Jan 01, 2012 5:20 am

Dendroaspis_bastian wrote:Well, I've had some hands on experience with venomous snakes, but I mostly do the work behind the scenes of analyzing venoms which come from snakes milked in zoos, reptile parks, and various other private and public institutions. I know how the venom of these snakes works and I wasn't saying anything to anyone here. I was addressing yoson10 and his claims of "paralysis after 10 minutes". That just doesn't happen in general. It might if the hit is IV, but otherwise no. He will never be able to materialize paralysis from any cobra bite (non-IV) in 10 minutes. 30 minutes, yes. 10 minutes, never.

I studied clinical laboratory science, with strong emphasis on toxicology. I worked for years in a microbio lab, but now I'm working in a clinical chemistry lab (toxicology).


The 10 minute claim was based on a hands on account that I was personally present for in India..But the fact remains...You argued that Cobra venom is slow acting which is complete bullshit...Cobra venom is very fast acting..

I can find tons of 30 minute paralysis and maybe even a few cases of 10 minute paralysis...But the point remains. You argued strongly that Cobras have slow acting venom and thats obviously not an accurate viewpoint.
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Re: First time ever treatment for Snouted cobra bite

Postby yoson10 » Sun Jan 01, 2012 5:24 am

Dendroaspis_bastian wrote:Nothing you said contradicts what I said. First, the Philippine cobra is considered to be the most venomous of all the Naja species.


What the hell does being "more venomous" have to do with how fast the venom acts? Nothing...The Phillipine cobra is a very venomous snake by cobra standards to humans but that has nothing to do with how fast its venom acts...Venom toxicity does NOT correlate with venom speed

Dendroaspis_bastian wrote:The Indian cobra, monocled cobra, and even the king cobra (though not a true cobra) are in fact less venomous than the species I first mentioned.
.


There is no such thing as more/less venomous...just more or less venomous to a PARTICULAR animal..

Naja atra is not more venomous to humans than Naja naja...Most Naja atra bites cause more local than systematic symptoms.
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Re: First time ever treatment for Snouted cobra bite

Postby yoson10 » Sun Jan 01, 2012 5:39 am

Dendroaspis_bastian wrote:
meaning for an elapid, the venom is slow to act. .


I don't have time to do extensive research tonight( because it's New Years)...but I found this in about 2 minutes

http://www.slideshare.net/Tshering_Namg ... management

Cobra versus krait bites

"Patients with cobra( Naja naja) bite presented with early neuroparalysis and
rapid onset of respiratory failure (15 minutes to 7 hours, mean 96.4
minutes). Recovery in these patients was also fast (1–24 hours,
mean 4.7 hours).

Patients with krait bite presented with late neuroparalysis and
delayed onset of respiratory failure (30 minutes to 16 hours, mean
246.5 minutes). They did not show marked improvement with
neostigmine and atropine. Recovery of neuroparalysis and respiratory
failure in krait bite was delayed (4–72 hours, mean 22.9
hours). Respiratory paralysis lasted less than 12 hours in 3
patients, between 12 and 24 hours in 4 patients and 36, 42 and 43
hours in 1 patient each."

http://www.nmji.in/archives/Volume_18-2 ... 9-75_3.pdf

So according to you 10 minutes has NEVER happened...Then I do research for 5 minutes and in the first study I find I already find a case of 15 minute paralysis...And of course you can't get out of your dumb claim that cobras have slow acting venom...when virtually every study indicates they( Naja naja) have a very fast acting venom.


Whats interesting in this study is that Naja naja bites actually cause worse symptoms and a higher rate of respiratory failure than the Common Krait...When in almost all the other studies I have read....the Krait cause higher rates of respiratory failure. Maybe just a fluke study?

Complications of snake-bite
"Table I lists the complications of snake-bite observed in this study.
Respiratory paralysis was the commonest acute complication. It
was seen in 50.7% of patients bitten by a cobra and in 31% of those
bitten by a krait. Following a Russell viper bite, shock developed
in 35% of patients, bradycardia in 17.5% and acute renal failure
in 30%. Anaphylaxis due to ASV occurred in 11.7% of the patients
to whom ASV was administered. The commonest delayed complication
was a non-healing ulcer at the site of the bite. This was seen
in 35.2% of the victims of cobra bite and in 15% of those bitten by
a Russell viper."

http://www.nmji.in/archives/Volume_18-2 ... 9-75_3.pdf


Another interesting thing is that the saw scaled viper in this particular region of west India does not really cause medically significant bites...Most bites by the saw scaled in this study were fairly mild.
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Re: First time ever treatment for Snouted cobra bite

Postby yoson10 » Sun Jan 01, 2012 6:01 am

Here is another thing I found in 2 minutes...Warning some of the pictures in the link are very graphic.

"AVRI assists with a snakebite case in India! This man was bitten on 5-11-2010. He lost consciousness within 3 minutes. Twenty-nine vials of antivenom were administered. His partner emailed us with a plea for help when his hand swelled and started to turn black. 5-20-10 his wife drained 1 liter of pus from the hand. We were able to get a number and consult with him via phone in India. On 5-21-10 the wound was debrided, systemic antibiotics started and the hand saved! Special thanks to Dr. Dan Keyler for helping with this! The whole incident was a team effort."
http://www.usavri.org/India%20Snakebite%20Case.html


I'm not sure if that means respiratory failure or just general unconsciousness..The man was quickly not breathing and was put on a ventilator but I can't say for certain if he went into respirator failure in just 3 minutes.

But that's enough for tonight...I will find more tomorrow and there are plenty of other accounts of extremely fast respiratory paralysis occurring following Naja naja bites.
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Re: First time ever treatment for Snouted cobra bite

Postby armata » Sun Jan 01, 2012 2:01 pm

I do not know if this is relevant - but with my Cape cobra bite last March I lost my vision in ten minutes and was unconcious in 20 minutes and stopped breathing - I think that is fast!
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Re: First time ever treatment for Snouted cobra bite

Postby WW » Sun Jan 01, 2012 2:21 pm

Conclusion: Clinical observations trump clinical laboratory science ;)
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Re: First time ever treatment for Snouted cobra bite

Postby Sico » Sun Jan 01, 2012 7:34 pm

Well said WW, and I fully agree. Anything can be shown in a lab, which does not neccesarily mean it will correlate to an actual case. How many medications worked perfectly in lab tests and studies, and then were later recalled due to massive unforseen detrimental side effects... Same thing with working with Venoms.
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Re: First time ever treatment for Snouted cobra bite

Postby MrG » Mon Jan 02, 2012 7:05 am

Very interesting read.

It would be good if more Dr's working in local hospitals could read this. Most of them would treat snakebite victims symptomaticly anyway(which might be not a bad option). Other treatment could be adressed with CME's, articels in medical journals etc, but I bet you most would not know about this.

Each case differs as BV pointed out with this latest victim and the severity of the bite.. For me the anti-venom might be more dangerous than the actual envenomation, but with others not. I know of a spesific person tagged twice by N. annulifera. First time he received anti-venom, second time none and in both cases he survived without any major complications, accept for some minor tissue damage.

By sharing your views here I have learned a lot more, thx !!!
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Re: First time ever treatment for Snouted cobra bite

Postby Nasicornis » Fri Feb 07, 2014 9:14 am

Ok, first off, I know this is a very old topic (although very interesting) but just to get back to the point. What would be the "expected" time of an adult N. annulifera and N. melanoleuca in case of an IV bite with regards to the onset of serious symptoms?
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Re: First time ever treatment for Snouted cobra bite

Postby froot » Mon Feb 10, 2014 4:33 pm

http://blogs.howstuffworks.com/keep-asking/how-fast-does-blood-flow-throughout-the-human-body/

So - IV bite, seconds.
How long it takes the venom to act on body tissues and produce symptoms? Dunno, not long.
Are the symptoms you're seeing from venom action or an allergic reaction? Refer to medical diagnostics.
Would the amount of venom injected expedite the onset of symptoms? Probably
Would the amount of venom adjust the chances of an allergic reaction? Probably
Hard to answer a question where the answer harbors so many variables, not to mention the venom property variations over these species' geographical range.

Either way it doesn't really matter if knowing this cannot get you to medical attention any sooner.

Maybe the right question should be - How long after a bite with no symptoms shown can you be certain it was a dry bite?
Then I would speculate - 4 hours for the 2 species mentioned.
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Re: First time ever treatment for Snouted cobra bite

Postby Bushviper » Tue Feb 11, 2014 9:07 am

With neurotoxins the symptoms can be delayed for up to 8 hours. That is very unusual and you should show some symptoms before then however they can rapidly become life threatening after a long fairly dormant period.
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