Lizard Envenomation Follow-up

Updated: Oct 27, 2015
  • Author: Robert L Norris, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Follow-up

Further Outpatient Care

All victims of helodermatid bites should be observed in the ED for at least 6 hours.

Reliable patients who are relatively asymptomatic, with normal vital signs and lab findings, can be discharged with instructions to return for any worsening symptoms. A responsible adult should be available to help the patient return if necessary.

Provide instructions for wound care (eg, wash the wounds twice per day with soap and water; apply a topical antibiotic ointment and dressing).

Signs and symptoms of wound infection should be discussed with the patient.

Arrange a follow-up appointment for a wound check in 24-48 hours.

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Further Inpatient Care

Admit patients with a significant systemic reaction or with abnormal lab studies and/or ECG findings, possibly to a monitored setting.

The bitten extremity should be placed in a well-padded splint and elevated to the patient's heart level or higher to reduce edema.

Institute standard daily wound care, including cleansing, topical antibiotic application, and dressing.

Physical therapy can help speed the return to full function.

Admission for pain control may be warranted.

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Inpatient & Outpatient Medications

Give a prescription for antibiotics (eg, cephalexin) to patients who are being prophylactically treated.

A prescription for a narcotic analgesic, such as hydrocodone, may be appropriate.

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Transfer

Transfer of victims with evidence of severe envenoming to a center with experience in dealing with these cases may be prudent. Consultation with an experienced provider is recommended (see Consultations above).

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Deterrence/Prevention

Avoid handling or otherwise disturbing venomous lizards.

Because these creatures spend approximately 99% of their lives underground, the opportunity to see one in the wild is a great privilege. The urge to pick up or capture it should be strongly suppressed. These animals are legally protected in all regions in which they occur.

A Gila monster (Heloderma suspectum). Photo by Hol A Gila monster (Heloderma suspectum). Photo by Holly McNally.
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Complications

Any of the attendant complications of shock may be encountered.

Myocardial infarction may occur.

Coagulopathy is a rare complication.

Wound infections may occur, especially in the setting of a retained tooth.

Necrosis is notably rare.

Allergic or anaphylactic reactions are also rare, but have been described. [5]

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Prognosis

The prognosis is excellent for those with a lizard envenomation, although pain may be an issue for many days. No substantiated deaths caused solely by a Gila monster bite have occurred in the United States.19 It is believed that a prolonged bite received by a small individual, such as an infant or toddler, could result in death.

Severe pain following a helodermatid bite may last many hours and generalized weakness can persist for several days. Described rare complications include shock, myocardial infarction, allergic/anaphylactic reaction, and coagulopathy. [7, 5, 8]

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Patient Education

Bitten victims should receive instructions regarding standard wound care, elevation of the bitten extremity, signs and symptoms of infection, and medications to be taken.

Patients should be educated to avoid close interactions with potentially dangerous wildlife in the future.

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