Lizard bites: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gila monster2.jpg|thumb|Glia monster.]] | |||
[[File:Mexican-Beaded-Lizard.jpg|thumb|Mexican Beaded Lizard.]] | |||
*Only two venomous lizard species in the world | *Only two venomous lizard species in the world | ||
*Venom secreted from glands in mucosa of lower jaw | *Venom secreted from glands in mucosa of lower jaw | ||
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*Geographic Distribution: Southwestern United States and Northwestern Mexico | *Geographic Distribution: Southwestern United States and Northwestern Mexico | ||
===Mexican | ===Mexican Beaded Lizard=== | ||
*Species: ''Heloderma horridum'' | *Species: ''Heloderma horridum'' | ||
*Geographic Distribution: Central and Southern Mexico | *Geographic Distribution: Central and Southern Mexico | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Bites and stings DDX}} | |||
==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
*CBC, BMP, and coagulation studies to rule out DIC | |||
*Consider EKG | |||
*X-ray of site to rule out retained tooth fragment | |||
===Diagnosis=== | ===Diagnosis=== | ||
*Typically a clinical diagnosis | |||
==Management== | ==Management== | ||
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**Lizards have very tenacious bites and need active detachment | **Lizards have very tenacious bites and need active detachment | ||
**Place under running hot water or use tongs or a stick | **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 | *Explore, clean and irrigate wound | ||
*Tetanus prophylaxis | *Tetanus prophylaxis | ||
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*If normal vitals and labs, can be discharged home after ED observation | *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 | *Observation is recommended if patient has any vital sign or lab abnormalities suggestive of envenomation | ||
==External Links== | ==External Links== | ||
==See Also== | |||
*[[Envenomations, bites and stings]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Environmental]] | |||
[[Category:Dermatology]] | |||
Latest revision as of 03:11, 27 November 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
Envenomations, bites and stings
- Hymenoptera stings (bees, wasps, ants)
- Mammalian bites
- Closed fist infection (Fight bite)
- Dog bite
- Marine toxins and envenomations
- Toxins (ciguatera, neurotoxic shellfish poisoning, paralytic shellfish poisoning, scombroid, tetrodotoxin
- Stingers (stingray injury)
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish, cone shells, lionfish, sea urchins)
- Nematocysts (coral reef, fire coral, box jellyfish, sea wasp, portuguese man-of-war, sea anemones)
- Phylum porifera (sponges)
- Bites (alligator/crocodile, octopus, shark)
- Scorpion envenomation
- Reptile envenomation
- Spider bites
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