The causative snake species, their venoms and envenoming apparatus, and the epidemiology, clinical profile, and management of envenomed humans is discussed. Australian snakes dangerous to man are elapids, in five groups corresponding to available monovalent antivenoms. The principle systemic effects of their venoms comprise neurotoxicity (N), defibrination type coagulopathy (C), myotoxicity (M), and renal damage (R), the latter possibly secondary in many cases. Major local effects of bites are not usually seen, but some groups commonly cause local edema (E). The groups are: (1) Brown snakes (Pseudonaja) = C,R,N; (2) Tiger snakes (Notechis, Tropidechis, Austrelaps) = N,C,M,R,E; (3) Mulga snakes (Pseudechis) = M,R,E; (4) Death adders (Acanthophis) = N; Taipans (Oxyuranus) = N,C,M,R,E. Dry bites are common; Australian deaths from snakebites are approximately 1–2 per year. Bites with significant envenomation need rapid expert care and appreciation of common venom pathology profiles. Antivenom, preferably monovalent, is the mainstay of treatment in such cases. Venom detection kits allow identification of the causative snake and appropriate antivenom. Subcutaneous pretesting for antivenom allergy is an unacceptable practice in Australia.
References
1.
CoggerH.G.Reptiles and Amphibians of Australia. Sydney: A.H. and A.W. Reed, 1975
2.
BroadA.J.SutherlandS.K.CoulterA.R.The lethality in mice of dangerous Australian and other snake venoms. Toxicon1979; 17, 661–664
3.
CovacevichJ.PearnJ.WhiteJ.The world's most venomous snake. In: PearnJ.CovacevichJ. eds. Venoms and Victims, Brisbane: The Queensland Museum and Amphion Press, 1988, 111–120
4.
WhiteJ.PounderD.PearnJ.H.MorrisonJ.J.A perspective on the problems of snakebite in Australia. In: GriggG.ShineR.EhmannH. eds. Biology of Australasian Frogs and Reptiles, Sydney: Royal Zoological Society of N.S.W, 1985, 511–514
5.
CovacevichJ.Australia's dangerous snakes. In: PearnJ.CovacevichJ. eds. Venoms and Victims, Brisbane: The Queensland Museum and Amphion Press, 1988, 73–86
6.
CoggerH.G.The venomous land snakes. In: CovacevichJ.DavieP.PearnJ. eds. Toxic Plants and Animals: A Guide for Australia, Brisbane: The Queenland Museum, 1987, 341–355
7.
WilsonS.K.KnowlesD.G.Australia's Reptiles. Sydney: W. Collins, 1988
8.
WhiteJ.Ophidian envenomation: a South Australian perspective. Records Adelaide Children's Hospital1981; 2, 311–421
9.
FairleyN.H.The dentition and biting mechanism of Australian snakes. Med. J. Aust1929; 1, 313–327
10.
WhiteJ.Elapid snakes: venom production and bite mechanism. In: CovacevichJ.DavieP.PearnJ. eds. Toxic Plants and Animals: A Guide for Australia, Brisbane: The Queensland Museum, 1987, 357–367
11.
WhiteJ.Elapid snakes: aspects of envenomation. In: CovacevichJ.DavieP.PearnJ. eds. Toxic Plants and Animals: A Guide for Australia, Brisbane: The Queensland Museum, 1987, 391–429
12.
WhiteJ.Elapid snakes: management of bites. In: CovacevichJ.DavieP.PearnJ. eds. Toxic Plants and Animals: A Guide for Australia, Brisbane: The Queensland Museum, 1987, 431–457
13.
WhiteJ.Elapid snakes: venom toxicity and action. In: CovacevichJ.DavieP.PearnJ. eds. Toxic Plants and Animals: A Guide for Australia, Brisbane: The Queensland Museum, 1987, 369–389
14.
MorrisonJ.J.PearnJ.H.CoulterA.R.The mass of venom injected by two Elapidae: the taipan (Oxyuranus scutellatus) and the Australian Tiger snake (Notechis scutatus). Toxicon1982; 20, 739–745
15.
Kochva, E., Bdolah, A., Graur, D. and Wollberg, Z. Relationship between sarafotoxin and endothelin: a case of evolutionary exaptation. Toxicon (in press).
16.
MebsD.Pharmacology of reptilian venoms. In: GansC. ed. Biology of the Reptilia, Physiology B, Vol. 8. London: Academic Press, 1978, 437–560
17.
WilliamsV.WhiteJ.Variation in venom constituents in a single isolated population of peninsular tiger snake (Notechis ater niger). Toxicon1987; 25, 1240–1243
18.
WilliamsV.WhiteJ.SchwanerT.D.SparrowA.Variation in venom proteins from isolated populations of tiger snakes (Notechis ater niger, Notechis scutatus) in South Australia. Toxicon1988; 26, 1067–1075
19.
SwaroopS.GrabB.Snake bite mortality in the world. Bull World Health Org1954; 10, 35–76
20.
BroadA.SutherlandS.K.TannerC.CovacevichJ.Electrophoretic enzyme and preliminary toxicity studies of the venom of Parademansia microlepidotus (the small-scaled snake), with additional data on its distribution. (Serpentes: Elapidae). Memoirs Queensland Museum1978; 19, 319–329
21.
AcottC.J.Acute renal failure after envenomation by the common brown snake. Med J Aust1988; 149, 709–710
22.
WhiteJ.WilliamsV.Severe envenomation with convulsion following multiple bites by a common brown snake Pseudonaja textilis. Aust Paediatr J1989; 25, 109–111
23.
WhiteJ.Patterns of elapid envenomation and treatment in South Australia. Toxicon Suppl1983; 3, 489–491
24.
WhiteJ.A review of 105 cases of suspected snakebite in South Australia. In: GopalakrishnakoneP.TanC.K. eds. Progress in Venom and Toxin Research, Singapore: National University of Singapore, 1987, 15–19
25.
MunroJ.G.C.PearnJ.H.Snake bite in children: a five year population study from southeast Queensland. Aust Paediatr J1978; 14, 248–253
26.
JamiesonR.PearnJ.An epidemiological and clinical study of snake-bites in childhood. Med J Aust1989; 150, 698–702
27.
SutherlandS.K.LoveringK.E.Antivenoms: use and adverse reactions over a twelve month period in Australia and Papua New Guinea. Med J Aust1979; 2, 671–674
28.
TrincaJ.C.The treatment of snake bite. Med J Aust1963; 1, 275–280
29.
SutherlandS.K.Australian Animal Toxins. Melbourne: Oxford University Press, 1983
30.
PearnJ.Snakebite victims. In: PearnJ.CovacevichJ. eds. Venoms and Victims, Brisbane: The Queensland Museum and Amphion Press, 1988
31.
SutherlandS.K.CoulterA.R.Three instructive cases of tiger snake (Notechis scutatus) envenomation, and how a radioimmunoassay proved the diagnosis. Med J Aust1977; 2, 177–180
32.
ChampnessL.T.The defibrination syndrome following elapine snakebite in Papua. Papua New Guinea Med J1966; 9, 89–94
33.
SutherlandS.K.CoulterA.R.HarrisA.D.Rationalisation of first aid measures for elapid snake bite. Lancet1979183–186
34.
SutherlandS.K.CoulterA.R.HarrisA.D.LoveringK.E.RobertsI.D.A study of the major Australian snake venoms in the monkey (Macaca fascicularis); (1) The movement of injected venom; methods which retard this movement, and the response to antivenoms. Pathology1981; 13, 13–27
35.
PearnJ.H.MorrisonJ.J.CharlesN.MuriV.First aid for snake bite. Med J Aust1981; 2, 293–294
36.
MurrellG.The effectiveness of the pressure immobilisation first aid technique in the case of a tiger snake bite. Med J Aust1981; 2, 295
37.
BalmainR.McClellandK.L.Pantyhose compression bandage; first aid measure for snake bite. Med J Aust1982; 2, 240–241
38.
SutherlandS.K.CoulterA.R.HarrisA.D.Rapid death of a child after a taipan bite. Med J Aust1980; 1, 136
39.
FairleyN.H.The present position of snake bite and the snake bitten in Australia. Med J Aust1929; 1, 296–313
40.
CampbellC.H.Clinical aspects of snake bite in the Pacific area. Toxicon1969; 7, 25–28
41.
MalasitP.WarrellD.A.ChanthavanichP.et al.Prediction, prevention, and mechanism of early (anaphylactic) antivenom reactions in victims of snake bite. Br Med J1986; 292, 17–20
42.
WhiteJ.TomkinsD.StevenI.WilliamsV.Tiger snake bite. Records Adelaide Childrens Hosp1984; 3, 169–173
43.
WhiteJ.FassettR.Acute renal failure and coagulopathy after snake bite. Med J Aust1983; 2, 142–143
44.
MorrisonJ.J.PearnJ.H.CovacevichJ.NixonJ.Can Australians identify snakes?. Med J Aust1983; 2, 66–70
45.
WarrellD.A.PopeH.M.PrenticeC.R.M.Disseminated intravascular coagulation caused by the carpet viper (Echis carinatus); trial of heparin. Br J Haematol1976; 33, 335–342
46.
WattG.TheakstonR.D.G.HayesC.G.et al.Positive response to edrophonium in patients with neurotoxic envenoming by cobras (Naja naja philippinensis). N Engl J Med1986; 315, 1444–1448
