Lizard bites: Difference between revisions
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Revision as of 17:05, 17 March 2021
Background
- Only two venomous lizard species in the world
- Venom secreted from glands in mucosa of lower jaw
- ~70% of bites involve envenomation
- Dislodged teeth are common
- Tenacious biters that frequently involve forceful removal
Gila Monster
- Species: Heloderma suspectum
- Geographic Distribution: Southwestern United States and Northwestern Mexico
Mexican Beaded Lizard
- Species: Heloderma horridum
- Geographic Distribution: Central and Southern Mexico
Clinical Features
- Initial symptoms include localized throbbing and burning pain with progressive edema
- Systemic symptoms can include gastrointestinal distress, diaphoresis, paresthesia and dyspnea
- Bradykinin release can cause tachycardia and hypotension
Differential Diagnosis
Evaluation
Workup
- CBC, BMP, and coagulation studies to rule out DIC
- Consider EKG
- X-ray of site to rule out retained tooth fragment
Diagnosis
- Typically a clinical diagnosis
Management
- Removal of lizard
- Lizards have very tenacious bites and need active detachment
- Place under running hot water or use tongs or a stick
- IV Fluids as needed; if persistent hypotension, consider vasopressors
- Explore, clean and irrigate wound
- Tetanus prophylaxis
- Daily dressing changes with topical antiseptic
- Antibiotics not routinely needed
Disposition
- If normal vitals and labs, can be discharged home after ED observation
- Observation is recommended if patient has any vital sign or lab abnormalities suggestive of envenomation