Redback Spider Envenomation Treatment & Management

  • Author: Rebecca L Rubin, MD; Chief Editor: Joe Alcock, MD, MS   more...
 
Updated: Apr 16, 2012
 

Prehospital Care

  • Pressure immobilization of the bitten limb is not recommended due to the slow and non–life-threatening progression of symptoms. Pressure dressings may also exacerbate pain in the affected area.
  • Ice packs to the bite site and simple oral analgesia may be helpful.
  • Do not administer antivenom in the field due to the risk of a severe allergic reaction.
  • Collection of the spider may aid its proper identification at the emergency department.
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Emergency Department Care

  • In patients with severe symptoms and signs of envenomation, treatment with redback spider antivenom should be considered. The benefit of treatment with antivenom should be weighed against the risk of its possible complications, including but not limited to, anaphylaxis and serum sickness.
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Consultations

  • The local poison control center may be consulted for spider identification and management of severe envenomations.
  • A surgeon may be consulted if compartment syndrome is suspected.
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Contributor Information and Disclosures
Author

Rebecca L Rubin, MD  Clinical Assistant Instructor and Resident Physician, Department of Emergency Medicine, State University of New York Downstate/Kings County Hospital Center

Rebecca L Rubin, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Coauthor(s)

Sage W Wiener, MD  Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; Assistant Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center

Sage W Wiener, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, and Society for Academic Emergency Medicine

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.

Matthew M Rice, MD, JD, FACEP  Senior Vice President, Chief Medical Officer, Northwest Emergency Physicians of TeamHealth; Assistant Clinical Professor of Medicine, University of Washington School of Medicine

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: 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

Joe Alcock, MD, MS  Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center; 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.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Alexandr Rafailov, MD, and Mark A Silverberg, MD, to the development and writing of this article.

References

  1. White J. CSL Antivenom Handbook. 2nd ed. 2001. Available at http://www.toxinology.com/generic_static_files/cslb_index.html.

  2. Nimorakiotakis B, Winkel KD. Spider bite--the redback spider and its relatives. Aust Fam Physician. Mar 2004;33(3):153-7. [Medline]. [Full Text].

  3. Graudins A. Widow spider envenomation: Lactrodectism. In: Dart RC, ed. Medical Toxicology. 3rd ed. Lippincott Williams & Wilkins; 2003:1592-1595/248. [Full Text].

  4. Nicholson GM, Graudins A. Spiders of medical importance in the Asia-Pacific: atracotoxin, latrotoxin and related spider neurotoxins. Clin Exp Pharmacol Physiol. Sep 2002;29(9):785-94. [Medline].

  5. Ushkaryov YA, Volynski KE, Ashton AC. The multiple actions of black widow spider toxins and their selective use in neurosecretion studies. Toxicon. Apr 2004;43(5):527-42. [Medline].

  6. Australian Museum. Available at http://australianmuseum.net.au/Redback-Spiders.

  7. Mollison L, Liew D, McDermott R, Hatch F. Red-back spider envenomation in the red centre of Australia. Med J Aust. Dec 5-19 1994;161(11-12):701, 704-5. [Medline].

  8. Isbister GK, Gray MR. Latrodectism: a prospective cohort study of bites by formally identified redback spiders. Med J Aust. Oct 20 2003;179(8):455; author 455-6. [Medline].

  9. Isbister GK, Brown SG, Miller M, Tankel A, Macdonald E, Stokes B, et al. A randomised controlled trial of intramuscular vs. intravenous antivenom for latrodectism--the RAVE study. QJM. Jul 2008;101(7):557-65. [Medline].

  10. Hahn IH, Lewin N. Chapter 115: Arthropods. In: Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, Lewin NA, Nelson LS, eds. Goldfrank's Toxicologic Emergencies. 8th ed. New York, NY: McGraw-Hill; 2006.

  11. Isbister GK. Failure of intramuscular antivenom in Red-back spider envenoming. Emerg Med (Fremantle). Dec 2002;14(4):436-9. [Medline].

  12. Isbister GK, Sibbritt D. Developing a decision tree algorithm for the diagnosis of suspected spider bites. Emerg Med Australas. Apr 2004;16(2):161-6. [Medline].

 
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Female redback spider showing a distinctive red stripe over the abdomen. Image courtesy of John Paterson.
Female redback spider with egg sacs. Image courtesy of John Paterson.
Female redback spider. Image courtesy of John Paterson.
Female redback spider. Image courtesy of John Paterson.
 
 
 
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