FISH

POISONING

Fish poisoning
Definition ofFISH POISONING
- Acute
illness
resulting
consumption of fish:

from

the

a: illness due to eating fish that normally

contain neurotoxins in their flesh
b: illness due to eating stale fish:(1): a
histamine intoxication(2): a bacterial
food poisoning
*SA

Fish poisoning
The same rules about food safety and preparation apply to
fish as with any other food product. If fish is left out on a
work surface for any period of time then it will decay (or
go off) very quickly.
Raw and cooked fish must not come into contact
with each other due to the risk of cross
contamination. This means using separate utensils and
chopping boards for raw and cooked fish and wiping them
down after use.
Fish needs to be cooked thoroughly and at the
correct temperature.
One exception to this is sushi. Sushi is a popular
Japanese dish which consists of raw fish, e.g.
salmon, rolled in rice and seaweed. This is available in
restaurants and as ready prepared packs in supermarkets.
Generally, this is safe to eat as long as the fish used has*JOSH

Causes of fish poisoning

This type of food poisoning is caused by fish which
has been contaminated by:
Parasites
Toxins
Bacteria, e.g. E coli
Viruses, e.g. norovirus
Fish which can be eaten raw such as oysters or
mussels are always a risky choice as well as being a
likely candidate for food poisoning. So, if you enjoy
the taste of oysters, especially a raw one then be
aware that the odds of getting food poisoning are
quite high.
*JOSH

parasites
Food poisoning caused by parasites is rare,
especially in countries such as the UK. It occurs
as a result of eating raw fish which has been
contaminated with any of the following parasites:
Clonorchis sinensis
Anisakis
Diphyllobothrium
These are all names for different types of fish
tapeworms which enter the gastrointestinal
tract during consumption. Once there they cause
a range of problems which includes abdominal
pain, nausea, vomiting and diarrhoea.
*JOSH

toxins
There is a wide range of toxins
present in seawater which are
produced by any number of
agents such as marine plankton
and algae. These are capable of
a range of health problems such
asciguatera poisoningalthough
this is uncommon.
Shellfish toxin (Shellfish
poisoning)
*JOSH

Bacteria
A well known example of this
isE coli. This bacterium is
present in nearly all
types of shellfish as a
result of contact with water
contaminated by raw
sewage.
*JOSH

virus
The virus in this case is the
norovirus which is spread via
contaminated food and water, and
personal contact with someone who
is already infected.
There are two types of foods
which often cause an outbreak of
the norovirus: salads and shellfish.
In the latter case it usually occurs
due to insufficient heating of shellfish
before consumption.
*JOSH

SYMPTOMS OF
NOROVIRUS

Low-grade fever
Chills
Headache
Muscle aches
Fatigue
*JOSH

norovirus
Most of these symptoms aren't serious, but
diarrhea and vomiting can deplete your
body of the fluid it needs and you can
become dehydrated
DIAGNOSIS: Stool test.
small percentage of people who are
infected with norovirus never have any
symptoms, which suggests they might have
some natural protection from the virus.
*JOSH

Treatment for norovirus

Noroviruses, like other viruses, don't respond to
antibiotics, which are designed to kill bacteria. No
antiviral drug can treat noroviruses, but in healthy
people the illness should go away on its own within a
couple of days. Most people don't have any long-term
problems from the virus.
To prevent dehydration, make sure to drink plenty of
liquids, especially water and juices. Give children an
oral rehydration solution (such as Pedialyte) to
replace lost fluids and electrolytes. Avoid sugary
drinks, which can make diarrhea worse, as well
as alcohol and caffeinated beverages, which can
dehydrate you further.
Symptoms of dehydration include dizziness when
standing, dry mouth, and a decrease in urination. If
severe dehydration develops, contact your doctor. *JOSH

Types of FISH poisoning

Common types of fish poisoning includes:
Ciguatera poisoning
Scombroid poisoning
Pufferfish poisoning or Fugu poisoning
Shellfish poisoning

*SA

Ciguatera poisoning
This is a type of fish food
poisoning which occurs when
someone eats fish which have
become infected by toxins that
are produced by seaweed, algae
or coral. These are usually found
in tropical seawaters.
*SA

Causes of ciguatera poisoning

Ciguatera is the name given to food poisoning caused by

the ciguatoxin a type of toxin found in some species of
tropical fish. Other types of toxins include maitotoxin and
palytoxin.
This is produced by organisms called dinoflagellates
which live in both sea and fresh water environments. They
attach themselves to seaweed or algae where they are
consumed by fish, living in these waters.
Note: algae are a type of organism that has a similar
appearance to seaweed.
There are around 5 types of ciguatoxin.
What happens is that small, plant eating fish consume these
algae only to be themselves consumed by larger, meat
eating fish. This enables these toxins to move higher up the
food chain where they build up in strength over time.
So, if you eat fish which has consumed algae which is
infected with these toxins then you will develop ciguatera *SA

Symptoms of ciguatera
poisoning
Ciguetera poisoning affects the digestive,
neurological and cardiovascular systems. The
symptoms appear quickly, often within 12 hours of
consuming infected fish.
They include:
Nausea
Stomach pain
Vomiting
Diarrhoea
These are the first set of symptoms to appear
and last for a couple of days. These affect the
digestive system.
*SA

Symptoms of ciguatera
poisoning
The second set of symptoms affects the
neurological system. They include:
Poor co-ordination/lack of balance
Mental confusion
Pain in the teeth (may feel loose)
Dizziness
Muscle pains
Joint pain
Headaches
Hallucinations
These symptoms can appear in as little as a few hours
or after several days following consumption. They can
persist for up to several months.
*SA

Symptoms of ciguatera
toxin
The third set of symptoms affect the
cardiovascular system. They include a very slow
heart rate and high blood pressure which can
cause dizziness and physical weakness.
other symptoms of ciguatera poisoning:
Sweating
Chills
Stiff neck
Complications:
include long term fatigue, persistent headaches
and difficulty with balance and co-ordination.

*SA

Treatment for ciguatera

poisoning
Ciguatera poisoning cannot be cured. The
disease is managed and supported instead
with the aim of helping someone to recover
rather than an outright cure.
Most people recover but it takes a long time to do
so.
Some people suffer a relapse, often following
contact with certain allergens which may cause
long term damage.
Medication such as calcium channel blockers,
e.g. Verapamil may help to treat some of the
symptoms which occur after the initial digestive
stage.
*SA

Preventing ciguatera
toxin
One way is to avoid eating
large amounts of shellfish
especially those which live in
tropical waters. This is because
the ciguatera toxins tend to
live in tropical (and subtropical) seas such as the Pacific
Ocean
*SA

Scombroid poisoning
Scombrotoxin, also called scombroid
poisoning or histamine poisoning, occur
if fish is not properly refrigerated after it
has been caught or poor hygiene on the
part of the handler. What can happen is
that the fish becomes warm after capture
which causes it to release histamine
as part of a toxic reaction.
This histamine then causes a reaction within
the person who has eaten the fish.
*SA

Causes OF scombroid poisoning

if fish which has been caught is not stored at the correct
temperature within a refrigerator then it releases a toxin called
histidine. Histidine naturally occurs in most species of fish
and converts to histamine if the fish is exposed to a warm
environment.
This is why it is so important to keep fish at cold
temperatures.
If the fish is allowed to become too warm it then produces very
high levels of histamine which is part of the decaying process.
This process also produces other substances which form part of
the toxic side effects.
Examples of fish which contain this toxin include tuna, mackerel,
sardines and anchovies.
This type of food poisoning is not caused by a virus or
bacteria.
*SA

Symptoms of scombroid poisoning

The symptoms of this particular type of food poisoning appear
very quickly. In some cases, they occur within a few minutes of
eating the infected fish.
They include:
Nausea
Dizziness
Flushed face
Sweating
Burning taste in the mouth
Headache
Tachycardia (rapid heartbeat)
Stomach pain
These symptoms can be mistaken for an allergic reaction so
make sure that you mention that you have recently eaten fish.
*SA

Symptoms of scombroid poisoning

These then develop into the following:

Hives
Oedema (swelling)
Stomach cramps
Diarrhoea
Any diarrhoea is likely to be short term only.
In severe cases you may experience a swollen
tongue, blurred vision and difficulty in
breathing.
These symptoms tend to last for 24 hours at most
although they can return if you eat fish which has
not been stored at the correct temperature, or on a
bed of ice.
*SA

Treatment of scombroid poisoning

This usually involves fluids to treat

dehydration caused by vomiting or
diarrhoea and oxygen in cases of
respiratory distress.
A type of medication called an
antihistamine may also be given.
This nullifies the affects of histamine.
In other words, it blocks the effect of
histamine on the body.
*SA

antihistamines
loratadine (Claritin), is now available over the
counter. It does NOT tend to cause drowsiness or affect
learning in children. Longer-acting antihistamines cause
less drowsiness, can be equally effective, and usually
do not interfere with learning. These medications,
which require a prescription, include fexofenadine
(Allegra), and cetirizine (Zyrtec). Other
nonprescription antihistamines include
diphenhydramine (Benadryl), chlorpheniramine
maleate (Chlor-Trimeton, Coricidin) and clemastine
(Tavist). New to the market, and available by
prescription only, is an antihistamine nasal spray called
azelastine (Astelin)
*SA

Preventing scombroid poisoning

Be careful when eating canned fish such as
sardines or tuna. Try to ensure that any
fish you eat has been stored at the right
temperature via a fridge or within ice.
If you have bought any fish which you
think may have spoiled or gone offthen
do not eat this under any circumstances
but throw it away instead

*SA

Puffer fish poisoning

(FUGU POISONING)
Tetrodotoxin, also called pufferfish poisoning or
fugu poisoning, is a much rarer form of fish poisoning,
but it is potentially very serious. This is almost
exclusively associated with the consumption of the
pufferfish.
The different bacteria living in pufferfish liver,
gonads, intestines and skin, are known to synthesize
a very potent heat stable neurotoxin called
tetrodotoxin.
FUGU is a traditional delicacy, prepared and sold in
special restaurants where trained and licensed chefs
carefully remove the viscera to reduce the danger of
poisoning.
*KAY

Causes of puffer fish poisoning

The poison found in organs and
skin of the pufferfish, blowfish,
balloon fish, toads, sunfish,
porcupine fish, toadfish,
globefish, and swellfish is a
tetrodotoxin.
Tetrodotoxin is one of the most toxic
poisons found in nature which is
more toxic than cyanide to humans .
*KAY

Symptoms of puffer fish poisoning

Symptoms generally occur 10-45 minutes after
eating the pufferfish poison, victims experience
numbness around the mouth, trouble
coordinating movement, difficulty swallowing
within minutes of ingesting the toxin, excess
salivation, twitching, and loss of ability to
talk.
Symptoms progress rapidly to convulsions,
tingling in the extremities and paralysis that
spreads upward the body.
The victim goes into respiratory failure generally
leading to death.
*KAY

Tetrodotoxin intoxication is divided into

four stages based on neurologic signs:
Grade 1 Rapidly after ingestion (10 min to 2 hours) numbness
and/or paresthesia of the lips and tongue and often of fingers
occur.
Grade 2 Sensory symptoms progress markedly.
Grade 3 Muscular paralysis of extremities occur. Motor
incoordination progresses and paralysis develops, but
consciousness is maintained. Voice production is difficult because
of bulbar muscle paralysis.
Grade 4 Consciousness may progressively deteriorate and
respiratory paralysis can cause death.
*KAY

Treatment of puffer fish poisoning

Treatment for pufferfish poisoning consists of:
limiting the body's absorption of the toxin
Ingest activated charcoal to bind the toxin. This will prevent the toxin from being
further absorbed by your body and will lessen the severity of the situation.

Induce vomiting if you are conscious and you have ingested the fish
within 3 hours. Since absorption of the toxin is unwanted, vomiting the
toxin or tetrodotoxin is the best remedy. Rapidly turn the person onto his
or her side if vomiting occurs.
relieving symptoms, and
treating life-threatening complications.

There is no known antidote for tetrodotoxin.

The person may become paralyzed. Artificial
respirations may keep the person alive until medical
attention in a hospital's emergency department is possible.

*KAY

Preventing puffer fish poisoning

Some puffer fish are eaten,

but most consumers are not
able to distinguish the
dangerous versus safe
species. For this reason, the
safest recommendation is to
DO NOT eat puffer fish.
*KAY

Shellfish POISONING
Shellfish poisoning (shellfish
toxin) is a general term used to
indicate poisoning that occurs when
shellfish (mainly oysters, clams,
scallops or mussels) are eaten by
humans. Shellfish are usually
associated with saltwater habitats,
but some species inhabit freshwater.
Both freshwater and saltwater
shellfish may cause poisoning.
*KAY

clinical studies have separated the group

of shellfish poisonings into four groups:

Amnesic shellfish poisoning (ASP)

Diarrheal shellfish poisoning (DSP)
Neurotoxic shellfish poisoning (NSP)
Paralytic shellfish poisoning (PSP)

*KAY

Amnesic shellfish poisoning (ASP)

This is a very rare form of poisoning which occurs as a result of
eating infected shellfish. These shellfish will have consumed this
when feeding upon a type of algae called diatoms or brown algae
which produces the toxin domoic acid.
This toxin is found in sardines and anchovies as well as shellfish.
This neurotoxin causes a range of gastrointestinal symptoms
which include: vomiting, abdominal pain, and diarrhea which
appear within 24 hours of eating infected shellfish.
These are then followed by neurological symptoms which include:
headache, mental confusion, dizziness/disorientation,
memory loss, visual disturbances, and seizures
In severe cases, paralysis and even death may occur.
There is no known antidote so anyone with these symptoms
requires hospital treatment as soon as possible.

*KAY

Diarrheal shellfish poisoning (DSP)

Diarrhea is the main symptom - hence the name but it also includes other
symptoms such as nausea, vomiting, chills and abdominal pains.
This type of poisoning is caused by a variety of toxins which includes
okadaic acid and yessotoxin. Okadaic acid is the toxin which is directly
responsible for causing persistent diarrhoea.
These symptoms develop very quickly, usually within an hour after eating
contaminated shellfish. They last for a day or so and tend to resolve
themselves without the need for treatment.
The one exception to this is if someone experiences severe diarrhoea
which leads to dehydration. In this case they will require fluid
replacement therapy via an intravenous drip.
Depletion of fluids caused by diarrhoea and/or vomiting can be dealt with
at home if it is not severe. This means drinking plenty of fluids such as
water and adding electrolytes to them to replace those lost through this
illness.
These electrolytes are essential minerals such as sodium (salt) and
potassium which come in powder form and can be added to a glass of
water. They can be purchased over the counter at a local pharmacy.
*KAY

Neurotoxic shellfish poisoning (NSP)

Another type of poisoning which occurs following consumption

of infected shellfish. In this case, the shellfish contain a type of
toxin called brevetoxins which cause symptoms very similar to
those of paralytic poisoning or ciguatera poisoning.
Symptoms of neurotoxic poisoning include:

Numbness/tingling in the mouth, arms and legs

Dry mouth
Poor co-ordination
Slurring of the speech
Drowsiness
Nausea
Vomiting
Diarrhoea

This also causes both neurological and gastrointestinal

symptoms.
Recovery takes 2 to 3 days from neurotoxic poisoning.
*KAY

Paralytic shellfish poisoning (PSP)

This is the most common type of shellfish poisoning. It is caused by the

consumption of shellfish which contain a number of chemicals that are derived
from saxitoxin.
Saxitoxin is a neurotoxin which when consumed, attacks the nervous system
within humans as well as causing gastrointestinal illness.
Symptoms of paralytic poisoning include:
Tingling
Burning
Drowsiness
Lack of co-ordination/clumsiness
Slurred speech
Dry mouth
Choking feeling in throat
This also includes the usual symptoms of food poisoning, for example nausea,
vomiting and diarrhea.
These symptoms appear 30 minutes to an hour after consumption and can cause
serious damage such as muscle paralysis and respiratory failure which can
be fatal. This poisoning is particularly serious in children.

*KAY

Shellfish poisoning
Shellfish poisoning
type

Symptoms

Causes

amnesic

permanent short term domoic acid

memory loss, brain
damage, death

diarrheal

diarrhea, nausea,
vomiting

okadaic acid,
azaspiracid

neurotoxic

slurred speech,
nausea, vomiting

brevetoxins

paralytic

paresthesia,
coordination loss,
speech defects,
nausea, vomiting,
death

saxitoxin, neosaxiton and

gonyautoxins I to IV

*KAY

Treatment of shellfish poisoning

This often depends upon the species of shellfish and the
type of toxin (or toxins). But it is important to remember
that there are no specific treatments for these toxins.
As all of these forms of poisoning cause vomiting and
diarrhea then fluids will need to be replaced which have
become depleted as a result of these. This involves
drinking fluids which contain electrolytes to restore
essential vitamins and minerals.
Some cases will require hospital treatment especially those
which involve children or people with a medical condition
or a weakened immune system. This treatment will be
supportive and involve fluid replacement and medication.
Drugs such as antihistamines

*KAY

Preventing shellfish poisoning

If shellfish is cooked thoroughly and at the correct
temperature then it should not result in food poisoning.
Many species of shellfish contain bacteria such as E.coli
and viruses which include norovirus but these are
destroyed during cooking.
One exception to this is oysters which many people
enjoy eating raw. If this applies to you then be aware
that there will always be a risk with this and any other
type of raw fish.
This unfortunately, doesnt apply to toxins such as those
found in algae and marine organisms. This also includes
ciguatera poisoning as these toxins are impervious to
cooking, freezing, salting and pickling.
*KAY

Antibiotics used in fish poisoning

depends when:
If the fish poisoning is contaminated
with the causative agent E.coli
Treatment
Third-generation cephalosporins
(eg, ceftriaxone).

*JOSH

Symptoms of fish poisoning

These are similar to symptoms for other types of food poisoning and
include:
Nausea
Vomiting
Diarrhoea
Upset stomach
Stomach pains
Muscle/joint pains
Headache
These symptoms develop within 48 hours of eating contaminated fish.
The severity of these symptoms will vary between individuals. Some
people will have a much worse experience than others which may depend
upon how much contaminated fish they have eaten.
There are groups of people who for a variety of reasons, are at a greater
risk of getting this type of food poisoning. These include people with a
poorly functioning immune system, are currently suffering from a
medical condition or work in an environment where they handle raw fish.
If any of this applies to you then take a few extra precautions to reduce the
risk of this happening.
*JOSH

Treatment for fish poisoning

This depends upon the extent of your illness. If your food
poisoning is relatively mild then you can treat it at home.
This means bed rest and plenty of liquids.
If you are worried about the risk of dehydration then
replace any essential vitamins and minerals lost as a
result of your food poisoning. Drink plenty of fluids,
e.g. water but add a sachet of re-hydration salts to
it which will replace these as well as ensuring that you
are properly hydrated.
Dehydration is a major risk of food poisoning and is
something to avoid if possible. But if you do become
dehydrated then you will require hospital treatment.
This means re-hydration via an intravenous drip
*JOSH

Preventing fish poisoning

Can you prevent yourself from getting food poisoning from
fish?
You can reduce the likelihood of this happening by applying
a few common sense measures. These include:
Ensuring fish has been properly cooked or if eaten
raw (e.g. sushi) has been frozen beforehand.
Do not store fish especially shellfish in water
Separate raw fish from cooked fish
Wash your hands before and after handling fish.
Also wipe down any chopping boards, utensils and
kitchen worktops afterwards.
Store fish in the fridge as soon as possible after
purchase
*JOSH

Reptiles

 Reptiles
cold-bloodedegg-layingvertebrates that has
anoutercoveringofhorny scalesorplates
- Includes snakes,lizards,crocodiles,andturtles

Snakes - any limbless scaled reptiles with a long

tapering body and with salivary glands often
modified to produce venom which is injected
through grooved or tubular fangs
Lizards are reptiles that typically has a long body
and tail, four legs, movable eyelids, and a rough,
scaly, or spiny skin.
Crocodiles - large carnivorous thick-skinned longbodied semi-aquatic reptiles
Turtles - a slow-moving reptile, enclosed in a scaly
or leathery domed shell into which it can retract
its head and thick legs.

Venom
- a poisonous substance secreted
by animals
Envenomation
the process by whichvenomis
injected into some animal by the
bite (or sting) of a venomous
animal

Lizards

Lizards
Family: Helodermatidae
Genus : Heloderma
Beaded Lizard (H. horridum)
Gila monster (H. suspectum)
Are the only lizards known to have evolved
an overt venom delivery system
Helodermameans "studded skin"
(Ancient Greek: hlosthe head of a nail or
stud anddrma meaning skin.)
Horrdum, is theLatinword meaning
rough or rude

Type of Poison

(1.) Neurotoxin
a substance which inhibits the functions of neurons
Action: damage neurons so that they cannot function.
attack the signaling capability of neurons
blocks the release of various chemicals
interfering with the methods of reception/transmissions/sending of false
signals

Effect : Neuromuscular paralysis

dizziness
drooping eyelid (ptosis)
paralysis of
one or moreextraocular muscles (opthalmoplegia)
flaccid facial muscle paralysis
inability to
swallow
paralysis of larger muscle groups
paralysis of respiratory muscle
asphyxiation
coma
death

Type of Poison

(2.) Hemotoxin
are toxins that destroy red blood cells
,disrupt blood clotting, and/or cause organ
degeneration and generalized tissue
damage
Effect : swelling
necrosis
(tissues/organs)
cardiovascular damage
loss of blood pressure
death

Type of Poison

Constituents of Lizard Venom

Hyaluronidase
spreading factor
Hydrolase enzyme that degrades
hyaluronic acid
Result: increase tissue permeability
facilitates venom diffusion
into tissue
Hyaluronic acid
mucopolysaccharide that is an

Type of Poison

Serotonin
Neurotransmitter
Mediates inflammation,
vasodilation ,smooth muscle activity
and cause platelet aggregation
Neurons
Serotonin signal
smooth muscle activity

Type of Poison
Monoamine Oxidase
Break-down excess neurotransmitter (e.g.
serotonin)
Normal:
Abnormal:
neurotransmitter
neurotransmitter
synaptic gap

synaptic gap

Normal levels of MAO enzymes

activity
excess neurotransmitter

levels of MAO =

levels of

Type of Poison
Phospholipase A2
-

disrupts the release of neurotransmitter in nerve synapses

blocks
acetylcholine release
parasympatholytic effect
Increase heart rate
Mydriasis/cycloplegia/decre
ased lacrimation
Reduce secretion
relaxation
- indirect degranulating effect on mast cells
histamine
inflammation
increase
permeability
of capillaries

Type of Poison

Gila Toxin
-

lethal factor
3-5% of venom volume
action : release bradykinin from kininogen
effects : bradykinin
inflammation
vasodilation
fall of blood
pressure
bronchoconstriction
dry
cough
natriuresis
fall of blood
pressure

Type of Poison
Helotherime
- hypothermic toxin
- Action: inhibits Ca+ influx from
sarcoplasmic reticulum
- Result : muscle relaxation
- Effect : lethargy , partial paralysis of
rear limbs, intestinal
distention, lowering of body
temperature

Type of Poison

Helodermatine
- hypotensive enzyme
- kinin-like activity
induce vasodilation and
contraction of smooth muscle
- effects: dose-dependent decrease of
the arterial blood pressure.

Mechanism of Poisoning
Venom Glands
capillary action
release of venoms through
(Venom storage) the ducts in large teeths
(Lower Jaw)
(Lower Jaw)
Gilas/beaded lizards latch onto their victims &
chew to allow neurotoxins to move through
grooves in their teeth and into the open
wound

Mechanism of Poisoning
Venom
Open wound
release

LOCAL
Hyaluronidase

EFFECTS

Phospholipase A2

Other Proteolytic enzymes

increased tissue permeability

inhibits cellular respiration
local tissue damage
deeper penetration
cell membrane destruction
spread of other venom
Tissue necrosis
inhibits platelet aggregation
components
inflammatory response (release of histamine)

SYSTEMIC
Gila Toxin
Pain, hypotension

EFFECTS

Helotherime
Helodermatine
hypothermia, lethargy,

hypotension

Clinical Manifestations

Pain
Edema ( caused by Histamine &
Bradykinin)
Hypotension
Nausea
Vomiting
Weakness/ muscle paralysis
Diaphoresis (excessive sweating)-caused
by serotonin

Target Organ

Neurotoxins
Nervous System
(neurons,neurotransmit
ters)
Muscles
(skeletal,smooth)

Hemotoxins
- Circulatory
system
- Blood
vessels,blo
od,tissues

Type of
Exposure
Accidental
Dermal Bite

Antidote/Treatment
No antivenin is commercially available.
Treatment is supportive.
First Aid :
Disengage the lizard that is still attached to the victim
Irrigate the bite site w/ 2% Lidocaine
Probed the wound w/ 25-gauge needle to detect any
embedded tooth
Diazepam useful in sedating agitated or painful patient
Analgesic
Broad Spectrum antibiotic
*co-amoxiclav / doxycycline
*prevents infection of wound
Assessment & Monitoring
- development of hypotension/shock

Antidote/Treatment

Suction or compression may impede venom movement,

they are unproved.
Cryotherapy, tourniquet, and excision are dangerous and
should not be used.