Neostigmine in the treatment of snake accidents caused by Micrurus frontalis: report of two cases Neostigmina no tratamento dos acidentes ofídicos causados por Micrucurus frontalis: relato de dois casos

• Published in: Revista do Instituto de Medicina Tropical de São Paulo
• Main Authors: Oswaldo Vital Brazil, Ronan José Vieira
• Format: Article in Journal/Newspaper
• Language: English; Portuguese
• Published: Universidade de São Paulo 1996
• Subjects: Coral snake; Venom; Neostigmine; Anticholinesterase drugs; Envenomation; Arctic medicine. Tropical medicine; RC955-962; Arctic; Argentina; Argentine
• Online Access: https://doi.org/10.1590/S0036-46651996000100012; https://doaj.org/article/559683a1ed564064a7c75b1a03cd942f

Antivenom in order to be effective in the treatment of coral snake accidents must be injected very soon after the bite owing to the rapid rate of absorption of the venom neurotoxins. As this is not always possible, other forms of treatment besides serotherapy must be employed to avoid asphyxia and death. Neostigmine and artificial respiration are used for this purpose. Neostigmine restores neuromuscular transmission if the venom-induced blockade results from a reversible interaction of its neurotoxins with the end-plate receptors. This is the mechanism of the neuromuscular blockade produced by the venom of M. frontalis snakes from centereastern and southern Brazil, and Argentine. Neostigmine is able, therefore, to antagonize the blockade, and has been shown to be very effective in the treatment of the experimental envenomation of dogs and monkeys. In the present communication, two cases of M. frontalis accidents treated with antivenom and neostigmine are reported. In both, neostigmine was successful in producing regression of the paralysis, confirming the effectiveness shown in the treatment of the poisoning induced in animals by M. frontalis venom. O soro antipeçonhento específico para ser eficaz no tratamento dos acidentes causados pelas cobras corais deve ser administrado logo após a mordedura, uma vez que as neurotoxinas da peçonha são absorvidas muito rapidamente. Como isto não é sempre possível, outras formas de tratamento, além do soroterápico, devem ser empregadas para evitar a asfixia e morte do paciente. A administração da neostigmina e a respiração artificial são utilizadas com esse objetivo. A neostigmina restabelece a transmissão neuromuscular se o efeito da peçonha resultar de interação reversível de suas neurotoxinas com os receptores da placa terminal. É esse o mecanismo da ação das neurotoxinas da peçonha de M. frontalis de serpentes do centroeste e sul do Brasil, e da Argentina. Em conseqüência a neostigmina antagoniza o bloqueio neuromuscular produzido pela peçonha dessas serpentes e é muito ...