Lizard Envenomation Workup

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

Laboratory Studies

The most common CBC count finding is an elevation in the WBC count. In rare severe cases, a drop in the platelet count may occur.

Measure serum electrolyte levels, particularly if there is a history of significant underlying disease.

Helodermatid venoms do not appear to have any anticoagulant fractions. However, very rarely, reports of abnormal coagulation studies with severe bites have been documented. These rare coagulopathies are likely secondary to hemostatic changes occurring as a result of severe endothelial cell damage.

It is reasonable to obtain a prothrombin time, an activated partial thromboplastin time, a fibrinogen level, and a measure of fibrin degradation products.

Perform a urinalysis and look for any evidence of blood or casts.

A cardiac panel, including a CK-MB, myoglobin, and troponin should be obtained if the victim has evidence of hemodynamic instability, chest pain, or an abnormal ECG result.

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Imaging Studies

A chest radiograph should be obtained if the victim is experiencing chest pain, shortness of breath, or has significant comorbidities.

Soft tissue radiographs may be obtained to look for retained teeth, although the sensitivity is low. Occasionally, gas may be seen in the soft tissues and likely represents air introduced into the wound during the biting/chewing process. [6]   A bedside ultrasound might also reveal retained teeth.

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Other Tests

Obtaining an ECG is prudent.  T-wave abnormalities, conduction disturbances, and 2 cases of acute myocardial infarction (one in a young patient without chest pain who had a possible history of cocaine use but no other cardiac risk factors) have been reported. [7, 8]

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