Widow Spider Envenomation Treatment & Management

  • Author: Sean P Bush, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Oct 28, 2010
 

Prehospital Care

Support the airway, breathing, and circulation per ACLS protocols with oxygen, monitors, and intravenous line.

Negative pressure venom extraction devices (eg, The Extractor - Sawyer Products) have not been evaluated for treatment of widow spider envenomation.

Electric shock and various folk and herbal remedies lack therapeutic value and are potentially harmful.

Do not give antivenom in the field because of the risk of severe allergic complications.[12]

Attempts to secure the spider may be helpful in confirming widow spider envenomation.

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Emergency Department Care

Antivenom should be given for imminent risk of severe complication of envenomation (see Complications). The risk of allergy to antivenom must be weighed against the benefit of relieving prolonged discomfort, avoiding hospitalization, and preventing complications.[12]

Grade 1 - Mild envenomation

  • Local pain at envenomation site
  • Normal vital signs

Grade 2 - Moderate envenomation

  • Muscular pain in the envenomated extremity
  • Extension of muscular pain to the abdomen if bitten on a lower extremity or to the chest if envenomated on an upper extremity
  • Local diaphoresis of envenomation site or involved extremity
  • Normal vital signs

Grade 3 - Severe envenomation

  • Generalized muscular pain in the back, abdomen, and chest
  • Diaphoresis remote from envenomation site
  • Abnormal vital signs (blood pressure >140/90 mm Hg, pulse >100)
  • Nausea and vomiting
  • Headache
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Consultations

Local poison control centers may assist management of difficult envenomations.

The Antivenom Index, published by the American Zoo and Aquarium Association and the American Association of Poison Control Centers, lists the locations, amounts, and various types of antivenom stores.

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Contributor Information and Disclosures
Author

Sean P Bush, MD, FACEP  Professor of Emergency Medicine, Loma Linda University School of Medicine; Consulting Staff, Envenomation Specialist, Department of Emergency Medicine, Loma Linda University Medical Center

Sean P Bush, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, International Society on Toxicology, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Protherics Consulting fee Consulting; Nycomed (formerly Fougera) Grant/research funds Speaking and teaching; Rare Disease Therapeutics Grant/research funds Research; Bioclon Grant/research funds Research

Coauthor(s)

Jennifer C Smith, MD  Medical Toxicology Fellow, Banner Good Samaritan Poison Center

Jennifer C Smith, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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.

James Steven Walker, DO, MS  Clinical Professor of Surgery, Department of Surgery, University of Oklahoma College of Medicine

James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association

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. Bronstein AC, Spyker DA, Cantilena LR Jr, Green J, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Clin Toxicol (Phila). Dec 2007;45(8):815-917. [Medline].

  2. Langley RL, Morrow WE. Deaths resulting from animal attacks in the United States. Wild Environ Med. 1997;8:8-16.

  3. Watson WA, Litovitz TL, Klein-Schwartz W, Rodgers GC Jr, Youniss J, Reid N, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2004;22(5):335-404. [Medline].

  4. Gonzalez Valverde FM, Gomez Ramos MJ, Menarguez Pina F, Vazquez Rojas JL. [Fatal latrodectism in an elderly man]. Med Clin (Barc). Sep 22 2001;117(8):319. [Medline].

  5. Pneumatikos IA, Galiatsou E, Goe D, Kitsakos A, Nakos G, Vougiouklakis TG. Acute fatal toxic myocarditis after black widow spider envenomation. Ann Emerg Med. Jan 2003;41(1):158. [Medline].

  6. Hoxha R. Two Albanians die from black widow spider bites. BMJ. Aug 5 2006;333(7562):278. [Medline].

  7. Boyer Hassen LV, McNally JT, Binford GJ. Spider bites. In: Auerbach PS, ed. Wilderness Medicine. 4th ed. St. Louis: Mosby-Year Book; 2001:807-838.

  8. Clark RF, Wethern-Kestner S, Vance MV, Gerkin R. Clinical presentation and treatment of black widow spider envenomation: a review of 163 cases. Ann Emerg Med. Jul 1992;21(7):782-7. [Medline].

  9. Bush SP, Thomas TL, Chin ES. Envenomations in children. Pediatr Emerg Med Rep. 1997;2:1-12.

  10. Woestman R, Perkin R, Van Stralen D. The black widow: is she deadly to children?. Pediatr Emerg Care. Oct 1996;12(5):360-4. [Medline].

  11. Bush SP. Black widow spider envenomation mimicking cholecystitis. Am J Emerg Med. May 1999;17(3):315. [Medline].

  12. Allen RC, Norris RL. Delayed use of widow spider antivenin. Ann Emerg Med. Sep 1995;26(3):393-4. [Medline].

  13. Cohen J, Bush S. Case report: compartment syndrome after a suspected black widow spider bite. Ann Emerg Med. Apr 2005;45(4):414-6. [Medline].

  14. Bush SP, Naftel J. Injection of a whole black widow spider. Ann Emerg Med. Apr 1996;27(4):532-3. [Medline].

 
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Black widow spider (Latrodectus mactans) with egg sac. Photo by Sean Bush, MD.
Black widow spider (Latrodectus mactans) and offspring. Photo by Sean Bush, MD.
Black widow spider. Reprinted with permission from Cutis 1995; 56: 257.
 
 
 
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