NEUROTOXICITY, ANTICOAGULANT ACTIVITY AND EVIDENCE OF RHABDOMYOLYSIS IN PATIENTS BITTEN BY DEATH ADDERS (ACANTHOPHIS SP) IN SOUTHERN PAPUA-NEW-GUINEA

Thirty-two patients with enzyme-immunoassay-proven death adder (Acanth ophis sp.) bites were studied in Port Moresby, Papua New Guinea. Eight een were envenomed; local signs were rare and none had incoagulable bl ood, but ail except one had signs of neurotoxicity. Five (27.7%) enven omed patients required intubation and ventilation. One patient develop ed renal failure, previously undescribed following death adder bites. Laboratory investigations showed mild prolongation of prothrombin and partial thromboplastin times in some patients. In vitro studies showed that the venom contains anticoagulant activity, but does not cause fi brinogenolysis. In contrast to taipan envenoming, neurotoxicity did no t progress after antivenom administration, and there was reversal of n eurotoxicity, evident within 6 h, in three severely envenomed patients treated less than 12 h after the bite. One patient treated with antiv enom and anti-cholinesterases had the most dramatic response to treatm ent; the optimum management of bites by this species may include promp t treatment with both antivenom and anticholinesterases in addition to effective first aid.