Australian elapid snake envenomation in cats: Clinical priorities and approach

Abstract

Practical relevance: No fewer than 140 species of terrestrial snakes reside in Australia, 92 of which possess venom glands. With the exception of the brown tree snake, the venom-producing snakes belong to the family Elapidae. The venom of a number of elapid species is more toxic than that of the Indian cobra and eastern diamondback rattle snake, which has earned Australia its reputation for being home to the world's most venomous snakes. Clinical challenges: The diagnosis of elapid snake envenomation is not always easy. Identification of Australian snakes is not straightforward and there are no pathognomonic clinical signs. In cats, diagnosis of envenomation is confounded by the fact that, in most cases, there is a delay in seeking veterinary attention, probably because snake encounters are not usually witnessed by owners, and also because of the tendency of cats to hide and seek seclusion when unwell. Although the administration of antivenom is associated with improved outcomes, the snake venom detection kit and antivenom are expensive and so their use may be precluded if there are financial constraints. Evidence base: In providing comprehensive guidance on the diagnosis and treatment of Australian elapid snake envenomation in cats, the authors of this review draw on the published veterinary, medical and toxicology literature, as well as their professional experience as specialists in medicine, and emergency medicine and critical care.

Successful treatment of a potentially fatal eastern brown snake (Pseudonaja textilis) envenomation in a dog with tiger‐brown snake antivenom with serial quantification of venom antigen and antivenom concentrations in serum and urine

“…The dog in this report, however, had evidence of myopathy based on the serum CK and AST levels in the sample collected 18 h post‐antivenom. The moderate elevated creatine kinase (4384 U/L) and haemolysed serum observed in this case were managed by analgesia and fluid therapy alone 15,33 . Creatine kinase has previously been reported to be mildly elevated in some dogs after brown snake envenomation 13 .…”

“…It has been recommended, but never validated, by some veterinary clinicians that running SVDK on urine samples can be used to titrate the dose of antivenom. 15,27 Although this may appear logical and, if subjected to scientific validation, could be a reasonable approach, cases such as this one do not support that application. Given the cost of using the SVDK in this way, particularly because the cost rivals antivenom in recent years, the cost-benefit of using client resources on antivenom or further diagnostics should be taken into consideration.…”

“…Thus, the low concentration of apparent free venom in urine could already be bound to antivenom. It has been recommended, but never validated, by some veterinary clinicians that running SVDK on urine samples can be used to titrate the dose of antivenom 15,27 . Although this may appear logical and, if subjected to scientific validation, could be a reasonable approach, cases such as this one do not support that application.…”

“…The moderate elevated creatine kinase (4384 U/L) and haemolysed serum observed in this case were managed by analgesia and fluid therapy alone. 15,33 Creatine kinase has previously been reported to be mildly elevated in some dogs after brown snake envenomation. 13 In the area of southeast Queensland where this snakebite occurred, tiger snake (Notechis sp.)…”

“…The dog remained in hospital for another 24 h on intravenous fluid therapy as prophylactic treatment for potential renal injury. 12,15 The urinary catheter was removed 12 h after insertion as urine output was consistently appropriate, haematuria resolved, and he was ambulating well; the urine was clear on gross examination at this time. The dog was discharged home uneventfully at 36 h postantivenom.…”