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Spider Envenomation, Brown Recluse: Follow-up

Author: Thomas Arnold, MD, Medical Director, Louisiana Poison Control Center, Associate Professor and Chairman, Department of Emergency Medicine, Section of Clinical Toxicology, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: Aug 18, 2009

Follow-up

Further Inpatient Care

  • Admit patients to the hospital for observation if they have rapidly expanding lesions or show evidence of systemic toxicity.
    • Patients with rapidly expanding lesions require good conservative wound care, including splinting and elevation. Appropriately treat any bacterial superinfection that occurs.
    • Carefully manage fluid and electrolytes in patients with evidence of systemic loxoscelism. Monitor patients' renal status and provide blood transfusions as needed. A short course of oral prednisone may reduce hemolysis. These patients may be discharged when their renal and hematologic statuses are stable.

Further Outpatient Care

  • Before discharging patients from the hospital, instruct them on proper wound care techniques and in proper cooling of the lesion for the first 72 hours. Schedule patients for daily wound checks until the lesion is stable or improving.
  • At each follow-up visit for the first 72 hours, perform a urine bedside test for blood and a CBC with platelet count to assess for any evidence of systemic toxicity.
  • Inform patients that the development of fever or dark urine necessitates immediate return to the ED or a call to their primary physician.

Deterrence/Prevention

  • Persons living in endemic areas should wear protective clothing and remain attentive when venturing into habitats of the brown recluse spider.
  • Cobwebs and spiders should carefully be removed from under and behind beds. One should use caution when putting on clothing that has been kept in storage and not worn for some time.

Complications

  • Delayed skin grafting may be necessary after 4-6 weeks of standard therapy.
  • Losses of digits and amputations have been reported.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to warn patients about potential complications
  • Failure to arrange follow-up care
  • Failure to evaluate the patient for potential complications
  • Failure to diagnose brown recluse spider bite
  • Failure to consider G-6-PD status before initiation of dapsone therapy
 


More on Spider Envenomation, Brown Recluse

Overview: Spider Envenomation, Brown Recluse
Differential Diagnoses & Workup: Spider Envenomation, Brown Recluse
Treatment & Medication: Spider Envenomation, Brown Recluse
Follow-up: Spider Envenomation, Brown Recluse
Multimedia: Spider Envenomation, Brown Recluse
References
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References

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  15. Vetter RS, Barger DK. An infestation of 2,055 brown recluse spiders (Araneae: Sicariidae) and no envenomations in a Kansas home: implications for bite diagnoses in nonendemic areas. J Med Entomol. Nov 2002;39(6):948-51. [Medline].

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Further Reading

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Contributor Information and Disclosures

Author

Thomas Arnold, MD, Medical Director, Louisiana Poison Control Center, Associate Professor and Chairman, Department of Emergency Medicine, Section of Clinical Toxicology, Louisiana State University Health Sciences Center
Thomas Arnold, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Louisiana State Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Robert L Norris, MD, Associate 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.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & 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.

Managing Editor

James Steven Walker, DO, MS, Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center
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.

CME Editor

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

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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