1. Hypoesthesia and numbness or drowsiness 2. Itching of nose and throat 3. Impaired speech and tightness of jaw muscles 4. Restlessness and muscle twitching 5. Muscle spasms with pain, nausea, vomiting, incontinence, convulsions 6. Respiratory and/or circulatory distress
ANAPHYLAXIS: Rare, but reported with non-neurotoxic species
DEATHS: Occasional; due to neurotoxic species
TREATMENT
LOCAL FIRST AID:
1. Apply ice packs 2. Apply tourniquet if possible and as near sting site as possible. Loosen briefly every 10-15 minutes WARNING: Do not use morphine or opiates since they increase toxic effects
SYSTEMIC:
1. Specific antivenin available for many dangerous species; administered early, may be lifesaving 2. Calcium gluconate—10 ml of 10% solution IV immediately and prn to control muscle pain 3. Phenobarbital—30-60 mg orally for sedation and control of convulsions 4. Treat for shock as necessary ([Chart 1])