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Bite of Heloderma

Bite of Heloderma

(All from Careless Handling)

1 Pet Finger Shannon 1953
2 Pet Finger Shannon 1953
3 Demonstration Finger Tinkham 1956
4 Demonstration Thumb Grant and Henderson 1957
5 Demonstration Finger Albritton et al. 1970
6 Demonstration Finger Stahnke et al. 1970
7 Pet Hand Roller 1977
8 Pet Abdomen Heitschel 1986
9 Wild Capture Forearm Piacentine et al. 1986
10 Pet Hand Streiffer 1986
11 Wild Capture Forearm Bou-Abboud and Kardassakis
1988 and Preston 1989
12 Recent capture Calf Caravati and Hartsell 1994
13 Wild capture? Thumb Caravati and Hartsell 1994
14 Pet Shoulder Caravati and Hartsell 1994
15 Wild Capture Triceps Caravati and Hartsell 1994
16 Pet Finger Strimple et al. 1997
17 Pet Hand Cantrell 2003

TABLE 7 Heloderma Bite Cases Published in Peer-Reviewed Journals since 1950

Nevertheless, an analysis of the cases summarized in tables 7 and 8 is instructive. Most bites were to a finger or hand and came from pet Gila Monsters. These bites are more likely to produce intense pain and local edema but are less likely to produce more serious symptoms such as severe hypotension, cardiac and blood abnormalities, or shock. All bites resulted from careless handling, some of which occurred during public demonstrations or classroom lectures. Alcohol was involved in some of the most serious cases (Heitschel 1986; Piacentine et al. 1986; Caravati and Hartsell 1994).

Based on an examination of case histories by Bogert and Martin del Campo (1956), Russell and Bogert (1981), recent bite case reports (tables 7 and 8), and my knowledge of approximately 30 unreported or untreated bites over recent years, the most common signs and symptoms of Heloderma envenomation in humans are similar to those observed in other mammals (table 4). They include pain, local edema, and a feeling of weakness, faintness, or nausea.

Bleeding at the site of the bite may be profuse, not from anticoagulant effects of the venom, but from the lacerating effect of the teeth and tenacity of the bite (fig. 13). Pain, often severe, usually begins within minutes, and may last several hours. The pain has been described as a steady burning, like a spine imbedded in the flesh. Pain may spread well beyond the site of the bite; a person bitten on the arm may feel pain from the shoulder to the hand. Edema (swelling) can occur within minutes and extend well beyond the region of the bite (fig. 13).

A second set of relatively common symptoms includes hypotension, sweating, an increased heart rate, and vomiting. Blood chemistry changes, including elevated leukocyte count, reduced potassium levels, and reduced platelets, are occasionally shown in moderately severe cases (tables 7 and 8). There is limited evidence that previous exposure to Heloderma bites may sensitize some individuals and result in an allergic reaction to the venom (Cantrell 2003). More severe cases seem to result from bites located closer to the core of the victim's body, such as the abdomen, shoulder, calf, or forearm (tables 7 and 8). The most severe cases result in extreme hypotension, which may be accompanied by life-threatening anaphylaxis (Piacentine et al. 1986), coagulopathy and acute myocardial infarction (Bou-Abboud and Kardassakis 1988), or profuse diarrhea and lethargy (Heitschel 1986). These cases likely illustrate the powerful physiological effects of the kallikrein-like and bioactive peptides found in Heloderma venom.

(from Table 7)

Pain 82 1-3,5-8,10-13,15-17
Local edema swelling 82 1-7,9-11,13,15-17
Weakness, faintness, dizziness 65 1,3,4,6,8,11-13,-15-17
Nausea 65 2,3,5-8,10,12,14,16-17
Hypotension 47 6,8-14
Diaphoresis (sweating) 47 4,8-11,13,16-17
Tachycardia (elevated heart rate) 35 5,8,11,12,14,15
Vomiting 35 3,5,10,12,14,17
Leucocytosis (elevated WBC count) 29 6,8,11,12, 17
Hypesthesia (hypersensitivity around bite) 24 1,2,12,16
Reduced blood potassium levels 18 8,9,11
Reduced platelets 18 8,11,17
Cyanosis (bluish discoloration around bite) 13 3,8
Cardiac abnormalities 12 7,11
Swollen or painful lymph glands 12 10,11
Lethargy 12 8,14
Anaphylaxis 6-12 9, possibly 17
Diarrhea 6 8
Tinnitis (ringing in ears) 6 2
Exophthalmia or periorbital hemorrhage 6 8
Hypothermia 6 12
Miosis (contraction of pupil) 6 14

TABLE 8 Bite Signs/Symptoms and Their Frequency

In the most serious case, a young woman had hidden a Gila Monster under her sweater and walked into a tavern, whereupon the lizard bit her on the abdomen. Her screams alerted bar patrons of her condition, and her boyfriend removed the lizard by severing its head. When she arrived at the hospital, the woman was nearly incapacitated, showing severe pain, vomiting, and diarrhea. She remained in intensive care for 36 hours (Heitschel 1986). This case (the only female in the sample) is noteworthy because the victim's symptoms are similar to pancreatic cholera, a condition produced by VIP-secreting tumors and also known as WDHA (watery diarrhea, hypokalemia, acidosis) syndrome (Connigrave and Young 1996). Such symptoms may be an example of the action of VIP-like bioactive peptides in Heloderma venom.

References and table numbers refer to Ref. 1 (D.D. Beck 2005)

Treatment of bites