eMedicine Specialties > Emergency Medicine > Environmental

Spider Envenomation, Funnel Web: Follow-up

Author: Joe Alcock, MD, MS, Assistant Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center; Acting Chief, Emergency Medicine Service, New Mexico Veterans Affairs Health Care System
Contributor Information and Disclosures

Updated: Dec 4, 2008

Follow-up

Further Inpatient Care

  • Patients who respond to antivenom may be discharged within a day or so if no complications occur.
  • Management is more difficult if antivenom is unavailable; in such cases, the patient may need to spend many days in intensive care.
  • Important insights into management before the availability of antivenom have been provided by Fisher et al.3
  • Prolonged ventilation in the intensive care unit may be required for treatment of respiratory failure. Adequate sedation is essential.
  • Atropine has been used to provide parasympathetic blockade.
  • In the early stages, hypertension may be treated with alpha-blockers, but massive doses may be required.
  • Reversible agents are preferred because of the possible development of hypotension as envenomation progresses.
  • Theoretically, beta-blockade may be lethal (because of unopposed alpha-stimulation) and is not advocated.

Further Outpatient Care

  • Routine follow-up is not required; however, the theoretical risk of serum sickness caused by the foreign protein load of antivenom mandates that the patient be advised to report symptoms. Nevertheless, serum sickness has not yet been reported following treatment with funnel-web spider antivenom.

Complications

  • Once successfully treated with antivenom and recovered from the acute illness, patients are unlikely to experience further complications. As with all patients receiving antivenom, the patient should be advised to seek medical care if signs of serum sickness occur.

Prognosis

  • Only 1 in 10 people bitten by a funnel-web spider displays signs of envenomation; however, if envenomation occurs, mortality rates are high in patients who receive no antivenom treatment. Most patients who survive until antivenom can be administered are able to make a complete recovery.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Simon G A Brown, MBBS, PhD, FACEM, to the development and writing of this article.



More on Spider Envenomation, Funnel Web

Overview: Spider Envenomation, Funnel Web
Differential Diagnoses & Workup: Spider Envenomation, Funnel Web
Treatment & Medication: Spider Envenomation, Funnel Web
Follow-up: Spider Envenomation, Funnel Web
Multimedia: Spider Envenomation, Funnel Web
References
[ CLOSE WINDOW ]

References

  1. Isbister GK, Gray MR, Balit CR, Raven RJ, Stokes BJ, Porges K, et al. Funnel-web spider bite: a systematic review of recorded clinical cases. Med J Aust. Apr 18 2005;182(8):407-411. [Medline]. [Full Text].

  2. Isbister GK, Gray MR. Bites by Australian mygalomorph spiders (Araneae, Mygalomorphae), including funnel-web spiders (Atracinae) and mouse spiders (Actinopodidae: Missulena spp). Toxicon. 2004;43(2):133-40. [Medline].

  3. Fisher MM, Carr GA, McGuinness R, Warden JC. Atrax robustus envenomation. Anaesth Intensive Care. Nov 1980;8(4):410-20. [Medline].

  4. Dieckmann J, Prebble J, McDonogh A, Sara A, Fisher M. Efficacy of funnel-web spider antivenom in human envenomation by Hadronyche species. Med J Aust. Dec 4-18 1989;151(11-12):706-7. [Medline].

  5. Harrington AP, Raven RJ, Bowe PC, Hawdon GM, Winkel KD. Funnel-web spider (Hadronyche infensa) envenomations in coastal south-east Queensland. Med J Aust Med J Aust. Dec 6-20 1999;171(11-12):651-3. [Medline]. [Full Text].

  6. Howarth DM, Southee AE, Whyte IM. Lymphatic flow rates and first-aid in simulated peripheral snake or spider envenomation. Med J Aust. Dec 5-19 1994;161(11-12):695-700. [Medline].

  7. Sutherland SK. The Sydney funnel-web spider (Atrax robustus). 3. A review of some clinical records of human envenomation. Med J Aust. 1972;2:642-6.

  8. Sutherland SK, Duncan AW. New first-aid measures for envenomation: with special reference to bites by the Sydney funnel-web spider (Atrax robustus). Med J Aust. Apr 19 1980;1(8):378-9. [Medline].

  9. Sutherland SK, Duncan AW, Tibballs J. Local inactivation of funnel-web spider (Atrax robustus) venom by first- aid measures: potentially lifesaving part of treatment. Med J Aust. Oct 18 1980;2(8):435-7. [Medline].

  10. White J, Cardoso JL, Fan HW. Clinical toxicology of spider bites. In: Handbook of Clinical Toxicology of Animal Venoms and Poisons. CRC Press; 1995:272-83.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

funnel-web spider, funnel web spider, Sydney funnel web spider, spider bite treatment, spider bite symptoms, Atrax, Hadronyche, Atrax robustus, Hadronyche versuta, Hexathelidae, spider envenomation, spider bite, Australian funnel-web spider, delta-atracotoxins, robustotoxin, antivenom

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Joe Alcock, MD, MS, Assistant Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center; Acting Chief, Emergency Medicine Service, New Mexico Veterans Affairs Health Care System
Joe Alcock, MD, MS is a member of the following medical societies: American Academy of 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

Matthew M Rice, MD, JD, FACEP, Senior Vice President, Chief Medical Officer, Northwest Emergency Physicians; Assistant Clinical Professor of Medicine, University of Washington at Seattle
Matthew M Rice, MD, JD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Washington State Medical Association
Disclosure: Team Health  Salary Employment

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: eMedicine.com, Inc. Consulting fee Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
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.