Lizard Envenomation Clinical Presentation

  • Author: Robert L Norris, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Dec 14, 2011
 

History

The vast majority of individuals who are bitten by Gila monsters or beaded lizards are intentionally interacting with the animals, and the history of the bite usually is clear.

To help estimate the severity of envenomation, it is important to estimate the length of time the lizard remained attached to the victim. While an effective envenomation can occur with a contact time of a few seconds, if the lizard manages to hang on for a period of minutes, the bite could be very serious, potentially lethal.

The victim may present with many signs and symptoms, including the following:

  • Multiple lacerations that may bleed profusely
  • Severe throbbing or burning pain at the bite site that may radiate proximally
  • Discoloration at the bite site (eg, cyanosis, ecchymosis)
  • Generalized weakness
  • Nausea and vomiting
  • Shortness of breath
  • Sweating
  • Numbness
  • Dizziness
  • Faintness
  • Progressive edema
  • Painful lymph nodes
  • Angioedema
Next

Physical

Vital signs should be assessed and closely monitored.

Local signs

  • Multiple bleeding lacerations
  • Edema
  • Cyanosis or ecchymosis
  • Vasospasm
  • Retained teeth (Closely examine wounds and probe for foreign bodies.)
  • Necrosis (rare)

Systemic signs

  • Tachycardia
  • Hypotension
  • Respiratory distress
  • Diaphoresis
  • Lymphangitis and lymphadenopathy
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Robert L Norris, MD  Professor, Department of Surgery, Chief, Division of Emergency Medicine, Stanford University Medical Center

Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, California Medical Association, International Society of Toxinology, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark S Slabinski, MD, FACEP, FAAEM  Vice President, EMP Medical Group

Mark S Slabinski, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Ohio State Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

A Antoine Kazzi  MD, Deputy Chief of Staff, American University of Beirut Medical Center; Associate Professor, Department of Emergency Medicine, American University of Beirut, Lebanon

A Antoine Kazzi is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Mebs D. Clinical toxicology of Helodermatidae lizard bites. In: Handbook of Clinical Toxicology of Animal Venoms and Poisons. 1995: 361-366.

  2. Piacentine J, Curry SC, Ryan PJ. Life-threatening anaphylaxis following gila monster bite. Ann Emer Med. 1986;15:959-961. [Medline].

  3. Bou-Abboud CF, Kardassakis DG. Acute myocardial infarction following a Gila monster (Heloderma suspectum cinctum) bite. West J Med. 1988;148(5):577-579. [Medline].

  4. Preston CA. Hypotension, myocardial infarction, an coagulopathy following gila monster bite. J Emer Med. 1989;7:37-40. [Medline].

  5. Brown DE, Carmony NB. Gila Monster: Facts and Folklore of America's Aztec Lizard. 1991;1-126.

  6. Cantrell FL. Envenomation by the Mexican beaded lizard: a case report. J Toxicol Clin Toxicol. 2003;41(3):241-4. [Medline].

  7. Hooker KR, Caravati EM. Gila monster envenomation. Ann Emerg Med. 1994;24(4):731-735. [Medline].

  8. Kunkel DB. Bites of venomous reptiles. Emerg Med Clin North Am. Aug 1984;2(3):563-77. [Medline].

  9. Kunkel DB, Curry SC, Vance MV, Ryan PJ. Reptile envenomations. J Toxicol Clin Toxicol. 1983-84;21(4-5):503-26. [Medline].

  10. McNally J, Boesen K, Boyer L. Toxicologic information resources for reptile envenomations. Vet Clin North Am Exot Anim Pract. May 2008;11(2):389-401, viii. [Medline].

  11. Miller MF. Gila monster envenomation. Ann Emerg Med. May 1995;25(5):720. [Medline].

  12. Russell FE. Snake Venom Poisoning. Scholium International, Inc;1983:1-562.

  13. Stahnke HL, Heffron WA, Lewis DL. Bite of the Gila monster. Rocky Mt Med J. Sep 1970;67(9):25-30. [Medline].

  14. Streiffer RH. Bite of the venomous lizard, the Gila monster. Postgrad Med. Feb 1 1986;79(2):297-9, 302. [Medline].

  15. Strimple PD, Tomassoni AJ, Otten EJ. Report on envenomation by a Gila monster (Heloderma suspectum) with a discussion of venom apparatus, clinical findings, and treatment. Wilderness Environ Med. May 1997;8(2):111-6. [Medline].

 
Previous
Next
 
A Gila monster (Heloderma suspectum). Photo by Holly McNally.
Close-up of the head of a Gila monster. Clearly evident is the bulging musculature of the jaws, which gives this animal a tenacious bite. Photo by Holly McNally.
The dentition of a Gila monster. The grooved surfaces of the teeth are evident. These grooves allow for venom movement from the venom glands into the victim's tissues. Photo by Michael Cardwell.
A Gila monster (Heloderma suspectum). Photo by Michael Cardwell.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.