Black widow spider bite - Revision history

Rossdonaldson1: /* See Also */

2022-05-29T13:26:33Z

Idreamtichased: /* Management */

2022-04-28T18:16:56Z

Management

← Revisión anterior		Revisión del 18:16 28 abr 2022
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	**Dosage: Usual dose is one to two vials diluted in 50 to 100 mL 5% dextrose or 0.9% sodium chloride, then infused over 1 hour		**Dosage: Usual dose is one to two vials diluted in 50 to 100 mL 5% dextrose or 0.9% sodium chloride, then infused over 1 hour
	**Use is controversial - ''Morbidity'' (pain, cramping and autonomic disturbances) are high, but ''mortality'' is low. Antivenin is horse serum derived, and can lead to anaphylaxis and serum sickness		**Use is controversial - ''Morbidity'' (pain, cramping and autonomic disturbances) are high, but ''mortality'' is low. Antivenin is horse serum derived, and can lead to anaphylaxis and serum sickness
	**Consider for: Pediatric patients, pregnant women, elderly		**Consider for: Pediatric patients, pregnant women (category C), elderly

	===Not Indicated===		===Not Indicated===

Jonrako at 05:13, 17 January 2022

2022-01-17T05:13:14Z

← Revisión anterior		Revisión del 05:13 17 ene 2022
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	*Genus: ''Latrodectus''		*Genus: ''Latrodectus''
	*Black widows live in southern Canada and every U.S. state except Alaska. Bites are more common in warmer months <ref>Isbister GK, Fan HW. Spider bite. Lancet. 2011;378(9808):2039-2047. doi:10.1016/S0140-6736(10)62230-1</ref>		*Black widows live in southern Canada and every U.S. state except Alaska. Bites are more common in warmer months <ref>Isbister GK, Fan HW. Spider bite. Lancet. 2011;378(9808):2039-2047. doi:10.1016/S0140-6736(10)62230-1</ref>
	*Aptly ~~names~~ because of their sexual cannibalism (but only occurs approximately 2% of the time)		*Aptly named because of their sexual cannibalism (but only occurs approximately 2% of the time)<ref>Hack, J. (2021). Spider's Secret. ACEP NOW, 40(12), 16–18. </ref>
	*Most venomous spiders in North America, ~~venom~~ several times more potent than rattlesnake venom		*Most venomous spiders in North America<ref>Hack, J. (2021). Spider's Secret. ACEP NOW, 40(12), 16–18. </ref>
			**Venom several times more potent than rattlesnake venom
			*Most people who are envenomated have no serious damage due to the low volume of venom delivered.<ref>Hack, J. (2021). Spider's Secret. ACEP NOW, 40(12), 16–18. </ref>
			*Rarely bites can be fatal
			**High risk are the young, very old, and the infirm.<ref>Hack, J. (2021). Spider's Secret. ACEP NOW, 40(12), 16–18. </ref>

Jonrako: /* Background */

2022-01-17T05:03:16Z

Background

← Revisión anterior		Revisión del 05:03 17 ene 2022
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	*Identification: red hourglass on otherwise black spider. Females tend to be larger and deliver more venom <ref>Maretić Z. Latrodectism: variations in clinical manifestations provoked by Latrodectus species of spiders. Toxicon. 1983;21(4):457-466. doi:10.1016/0041-0101(83)90123-x </ref>		*Identification: red hourglass on otherwise black spider. Females tend to be larger and deliver more venom <ref>Maretić Z. Latrodectism: variations in clinical manifestations provoked by Latrodectus species of spiders. Toxicon. 1983;21(4):457-466. doi:10.1016/0041-0101(83)90123-x </ref>
	*Genus: ''Latrodectus''		*Genus: ''Latrodectus''
	*Black widows live in southern Canada and every U.S. state except Alaska. Bites are more common in warmer months <ref>Isbister GK, Fan HW. Spider bite. Lancet. 2011;378(9808):2039-2047. doi:10.1016/S0140-6736(10)62230-1</ref>		*Black widows live in southern Canada and every U.S. state except Alaska. Bites are more common in warmer months <ref>Isbister GK, Fan HW. Spider bite. Lancet. 2011;378(9808):2039-2047. doi:10.1016/S0140-6736(10)62230-1</ref>
			*Aptly names because of their sexual cannibalism (but only occurs approximately 2% of the time)
			*Most venomous spiders in North America, venom several times more potent than rattlesnake venom


	===Mechanism===		===Mechanism===

Rossdonaldson1 at 15:33, 20 May 2021

2021-05-20T15:33:49Z

← Revisión anterior		Revisión del 15:33 20 may 2021
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	==Background==		==Background==
			[[File:Western Black Widow (Latrodectus hesperus).jpg\|thumb\|Black widow spider]]
			[[File:Blackwidow macro.jpg\|thumb\|Classic "hourglass" marking shape on ventral side of ''L. hesperus''.]]
	*Identification: red hourglass on otherwise black spider. Females tend to be larger and deliver more venom <ref>Maretić Z. Latrodectism: variations in clinical manifestations provoked by Latrodectus species of spiders. Toxicon. 1983;21(4):457-466. doi:10.1016/0041-0101(83)90123-x </ref>		*Identification: red hourglass on otherwise black spider. Females tend to be larger and deliver more venom <ref>Maretić Z. Latrodectism: variations in clinical manifestations provoked by Latrodectus species of spiders. Toxicon. 1983;21(4):457-466. doi:10.1016/0041-0101(83)90123-x </ref>
	*Genus: ''Latrodectus''		*Genus: ''Latrodectus''
	*Black widows live in southern Canada and every U.S. state except Alaska. Bites are more common in warmer months <ref>Isbister GK, Fan HW. Spider bite. Lancet. 2011;378(9808):2039-2047. doi:10.1016/S0140-6736(10)62230-1</ref>		*Black widows live in southern Canada and every U.S. state except Alaska. Bites are more common in warmer months <ref>Isbister GK, Fan HW. Spider bite. Lancet. 2011;378(9808):2039-2047. doi:10.1016/S0140-6736(10)62230-1</ref>

	~~[[File:Western Black Widow (Latrodectus hesperus).jpg\|thumb\|Black widow spider]]~~

	===Mechanism===		===Mechanism===

Blsimpso: /* Background */

2021-05-15T00:14:48Z

Background

← Revisión anterior		Revisión del 00:14 15 may 2021
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	==Background==		==Background==
	*Identification: red hourglass on otherwise black spider		*Identification: red hourglass on otherwise black spider. Females tend to be larger and deliver more venom <ref>Maretić Z. Latrodectism: variations in clinical manifestations provoked by Latrodectus species of spiders. Toxicon. 1983;21(4):457-466. doi:10.1016/0041-0101(83)90123-x </ref>
	*Genus: ''Latrodectus''		*Genus: ''Latrodectus''
			*Black widows live in southern Canada and every U.S. state except Alaska. Bites are more common in warmer months <ref>Isbister GK, Fan HW. Spider bite. Lancet. 2011;378(9808):2039-2047. doi:10.1016/S0140-6736(10)62230-1</ref>

	[[File:Western Black Widow (Latrodectus hesperus).jpg\|thumb\|Black widow spider]]		[[File:Western Black Widow (Latrodectus hesperus).jpg\|thumb\|Black widow spider]]
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	===Local===		===Local===
	*Pinprick sensation; then increasing local pain that may spread to entire extremity		*Pinprick sensation; then increasing local pain that may spread to entire extremity
	*Erythema appears 20-60 min after the bite		*Erythema appears 20-60 min after the bite; may develop characteristic halo or targetoid lesion
	*Pain begins to abate after several hours and disappears by 2-3d		*Pain begins to abate after several hours and disappears by 2-3d

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	==Evaluation==		==Evaluation==
	*Generally clinical diagnosis		*Generally clinical diagnosis
			*For high-risk patients (pregnancy, children, older adults w/ cardiovascular issues), rule out peritonitis, UTI, and rhabdomyolysis
			**CBC
			**Creatinine phosphokinase
			**Lactic acid
			**UA

	==Management==		==Management==

ClaireLewis: /* Management */

2019-09-24T17:23:26Z

Management

← Revisión anterior		Revisión del 17:23 24 sep 2019
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	==Management==		==Management==
	*Local wound care, analgesia and [[tetanus prophylaxis]] are mainstays of treatment		*Local wound care, [[analgesia]] and [[tetanus prophylaxis]] are mainstays of treatment
	**Grade 1: Cold packs and [[NSAIDs]]		**Grade 1: Cold packs and [[NSAIDs]]
	**Grade 2/3: IV [[Opioids]] and [[Benzodiazepines]]		**Grade 2/3: IV [[Opioids]] and [[Benzodiazepines]]

ClaireLewis: /* Clinical Features */

2019-08-26T16:55:45Z

Clinical Features

← Revisión anterior		Revisión del 16:55 26 ago 2019
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	**Severe [[abdominal pain\|abdominal wall musculature pain]] and cramping		**Severe [[abdominal pain\|abdominal wall musculature pain]] and cramping
	**Difficult to differentiate from [[peritonitis]]		**Difficult to differentiate from [[peritonitis]]
	*[[Headache]], [[nausea/vomiting]], diaphoresis, [[photophobia]], [[dyspnea]]		*[[Headache]], [[nausea/vomiting]], diaphoresis, photophobia, [[dyspnea]]
	*[[A-fib]], [[myocarditis]], [[priapism]], and death are rare		*[[A-fib]], [[myocarditis]], [[priapism]], and death are rare

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	*Grade 1: Range from no symptoms to local pain at the envenomation site with normal vital signs		*Grade 1: Range from no symptoms to local pain at the envenomation site with normal vital signs
	*Grade 2: Involve muscular pain at the envenomation site to migration to the trunk, diaphoresis at bite site and normal vital signs		*Grade 2: Involve muscular pain at the envenomation site to migration to the trunk, diaphoresis at bite site and normal vital signs
	*Grade 3: Include grade 2 with abnormal vital signs; diaphoresis distant to envenomation site, generalized [[myalgia]] to back, chest and abdomen, nausea vomiting and headaches.		*Grade 3: Include grade 2 with abnormal vital signs; diaphoresis distant to envenomation site, generalized [[myalgia]] to back, chest and abdomen, nausea vomiting and headaches.

	==Differential Diagnosis==		==Differential Diagnosis==

ClaireLewis at 16:55, 26 August 2019

2019-08-26T16:55:18Z

← Revisión anterior		Revisión del 16:55 26 ago 2019
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	===Mechanism===		===Mechanism===
	*α-Latrotoxin envenomation causes massive release of neurotransmitters (norepinephrine, dopamine, acetylcholine, glutamate and GABA) from the nerve terminals → muscle cramps, tachycardia, hypertension		*α-Latrotoxin envenomation causes massive release of neurotransmitters (norepinephrine, dopamine, acetylcholine, glutamate and GABA) from the nerve terminals → muscle cramps, [[tachycardia]], [[hypertension]]
	*This clinical envenomation syndrome is known as latrodectism		*This clinical envenomation syndrome is known as ''latrodectism''

	==Clinical Features==		==Clinical Features==
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	*Muscle cramp-like spasms in large muscle groups (although exam rarely reveals rigidity)		*Muscle cramp-like spasms in large muscle groups (although exam rarely reveals rigidity)
	*Pain becomes generalized		*Pain becomes generalized
	**Severe abdominal wall musculature pain and cramping		**Severe [[abdominal pain\|abdominal wall musculature pain]] and cramping
	**Difficult to differentiate from peritonitis		**Difficult to differentiate from [[peritonitis]]
	*[[Headache]], [[nausea/vomiting]], diaphoresis, [[photophobia]], [[dyspnea]]		*[[Headache]], [[nausea/vomiting]], diaphoresis, [[photophobia]], [[dyspnea]]
	*[[A-fib]], [[myocarditis]], [[priapism]], and death are rare		*[[A-fib]], [[myocarditis]], [[priapism]], and death are rare
Línea 26:		Línea 26:
	*Grade 1: Range from no symptoms to local pain at the envenomation site with normal vital signs		*Grade 1: Range from no symptoms to local pain at the envenomation site with normal vital signs
	*Grade 2: Involve muscular pain at the envenomation site to migration to the trunk, diaphoresis at bite site and normal vital signs		*Grade 2: Involve muscular pain at the envenomation site to migration to the trunk, diaphoresis at bite site and normal vital signs
	*Grade 3: Include grade 2 with abnormal vital signs; diaphoresis distant to envenomation site, generalized ~~myalgias~~ to back, chest and abdomen, nausea vomiting and headaches.		*Grade 3: Include grade 2 with abnormal vital signs; diaphoresis distant to envenomation site, generalized [[myalgia]] to back, chest and abdomen, nausea vomiting and headaches.

	==Differential Diagnosis==		==Differential Diagnosis==

Kxl328: /* Systemic */

2018-10-23T03:42:40Z

Systemic

← Revisión anterior		Revisión del 03:42 23 oct 2018
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	*Pain becomes generalized		*Pain becomes generalized
	**Severe abdominal wall musculature pain and cramping		**Severe abdominal wall musculature pain and cramping
			**Difficult to differentiate from peritonitis
	*[[Headache]], [[nausea/vomiting]], diaphoresis, [[photophobia]], [[dyspnea]]		*[[Headache]], [[nausea/vomiting]], diaphoresis, [[photophobia]], [[dyspnea]]
	*[[A-fib]], [[myocarditis]], [[priapism]], and death are rare		*[[A-fib]], [[myocarditis]], [[priapism]], and death are rare

← Revisión anterior		Revisión del 13:26 29 may 2022
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	==See Also==		==See Also==
	*[[~~Envenomations,~~ bites ~~and stings~~]]		*[[Spider bites]]

	==External Links==		==External Links==