Urgent Treatment Methods for Intoxication Cases Caused by BLACK WIDOW Venom
	Area of Habitation and Specimen Description | Clinical Pattern and Diagnostics

  All the Patient with Black Widow bites are subject to immediate hospitalization!  

Method 1 | Method 2 | Method 3

Methods of Treatment Patients Intoxicated with Venoms of Insects  (the Black Widow, Scorpio, Tarantula) Using Low-Cost Medicines with High Efficiency Developers: Odessa State Medical University, Ministry of Health of Ukraine  Authors: О.І.Verba, S.І.Shatilov,  P.М.Chuyev, А.S.Vladika, О.О.Budnyuk

      Summary: The manner of treating the patients intoxicated with insects venom (the Black Widow spider, Scorpio, Tarantula) using simple low-cost medicines with high treatment efficiency.

      Proposed to be introduced into practical activities of medical establishments.

      The Arachnoidae specimen, possessing noxious for humans venom, are rather wide-spread at the Southern regions of Ukraine (territories of Odessa, Nikolaev, Kherson Regions), the Crimean Peninsula, Moldova, the Caucasus, in the dried plains, wastelands, heaps of garbage and stone and in walls of cattle stores made of clay. Their venom of toxalbuminous origin possesses neurotoxic features. After the bite a small, quickly disappearing spot emerges, after which severe pain arises in the location of the bite spreading to limbs, torso, chest, abdomen with severe tension in abdominal muscles (differential diagnostic pattern with so called "sharp belly" symptoms). Then come weakness, fever, hyperesthesia, heavy sweating, psychomotoric disturbance, hallucinations, fear of death feelings, tremour and fasciculary movements in muscles, breath difficulties, bronchoerea, nausea, vomitting, tachicardy, extracistoly, increased blood pressure. At the final stage facial muscles are affected with so called Facies LATRODECTISMICA symptome, itching, core-like висипання. Laboratory pattern may show apparent probable leicocitosys, hyperglicemia, increase of creatinphosphocinase content.
     In case of undue unreasonable delays in rendering urgent first aid and treatment severe complications are probable with high (up to 4 - 6% of total number of registered bites) lethal outcome statistics.

     The known methodics ot treatment for patients suffering the poisonous insects bites may be briefly outlined on the basis of sources, as below:  1.Ukrainian Patent No. 19421 А МКИ А6Ш5/06, 1997 "Methods of Treatment for Patients with Body Intoxication Applying the Introduction UV-processed Sterile 0,89% NaCl Solution."  2. "Immediate Therapy at the Initial Stage of Medical Assistance" /Programmes/ Edited by V. N. Mavrodiy Odessa Regional Authorities HPA, Odessa, 1999, p. 43 "The Black Widow Spider Bite".  3. "Acute Intoxications" Е.А. Luzhikov, L.G.Kostomarova, Moscow, "Medicine", 1989, p. 366, 372, 432). As a general feature, all the enlisted methodologies provide complex therapy with compulsory application of anti-Black Widow serum, and are efficient, but have essential disadvantages. Namely, in case of lack of the deficient expensive anti-Black Widow serum, the rest methods are low-efficient and don't guarantee the safe recovery of the patient. The essential difference of the proposed method from the above mentioned, lies in introducing sodium hypocloride (NaClO) into the body of the patient, suffering from the bites delivered by either Black Widow spider, or Scorpio, or Tarantula, which provides the source of active oxygen supply and, being introduced into body using any means releases active oxigen which deals with toxic substances in blood flow. 

     First Aid and Treatment Procedures:

1. At the first 2-3 minutes since the moment of the bite the location of bite may be burned in the flame of a match, for which 1-2 matches are tightly placed to the location of the bite and ignited with the third burning match. Since only the superficial layers of skin are affected, the heat generated by matches flame is sufficient to corrupt the toxins (Method by P.I. Marykovskiy).

2. Anti-Black Widow serum to be introduced in dosage depending on the degree of intoxication: in severe cases up to 2.000-2.500 dcl, in medium cases 1.500dcl, in slight cases 500-1.000 dcl. The serum is introduced normally in the upper spinal area, in severe cases - intravenously using the dripping system with preliminary adding it into 500-1.000 ml 0,9% NaCl solution).

3. Correction of the intoxication syndrome, pain syndrome and arterial hypertension.

а) Stadoli 2 mg intravenous dosage every six hours, tramadoli, cetolong, in case of apparent clearly expressed pain syndrome - analgetics (morphini 2% 1 ml intra-muscular, omnoponi 2% 1 ml intra-muscular, promedoli, etc);
b) In cases of psychomotoric disturbances: sybasoni 0,5% 2 ml intravenously or intra-muscular;
в) Anti-gystamine and hormone-containing medicines: suprastini, tagevili, dexametazone, etc.;
г) Berlitioni (alpha-lypoidic acid) 300 mg intravenous by dripping (previously solved in 200 ml 0,9 % NaCl), Ascorbinic acid 5% solution 10 ml intravenously (previously dissolved in 10 ml 0,9% NaCl solution);
д) Arterial hypertension correction: 10 ml intravenous slowly introducing 25% Magnesium Sulphate, etc.

4. In cases when anti-Black Widow serum is unavailable, the following methods are applicable:

а) Glukoze-Ethylalcohol-Novocaini mixture intravenously in droplets: 200 ml 5% Glucoze solution + 30 ml 30% Ethylalcohol Solution + up to 200 ml  0,25% Novocaini Solution. If required the mixture shall be introduced 2-3 times per day; 
б) Non-direct electrochemical blood oxidation with 0,06 Sodium Hypochlorid Solution. Dosage 5 mg/kg body weight every  8-12 hours for 5 days. Desirable to infuse via large blood vessels using catheter. Contraindications against intravascular Sodium Hypochloride introduction may only be the apparent failures in blood coagulation processes and hyperglicemia.

Method 1 | Method 2 | Method 3

Methodical Recommendations on First Aid and Treatment in Cases of the Black Widow Venom Intoxications. The Danube Basin Hospital on the Water Transport, Izmail City, Dr. A. I. Verba, Chief Physician, Dr. S. I. Shatilov, Toxicologist

     The Black Widow Spider is the most dangerous for humans and animals of the entire scope of Arachnoidae specimen inhabiting in Kazakhstan, Central Asia and Southern part of Ukraine. This specimen of spiders inhabits zones of mild and tropical climate in stone heaps, cracks in buildings, stocks of dried garbage and grass. The younger imagoes exuviate frequently and have whitish pattern on the black background on the top of belly and only fully-matured acquire absolutely black colour with typical burnish without any spots and patterns.
     The female spider is 8-15 mm in size with round belly without any reddish or orange marks on the inside typical for some of the diversities inhabiting America (Latrodectus mactans) and Australia. The male spider is much smaller (3-5 mm), and lighter in colour.
     The females are the most poisonous and the main feature of their behaviour is their addiction to twine their webs around any openings or holes made by humans, including even the hole in a toilet in the yard. The bites occur when the cobweb of the spider are disturbed by a human or an animal or when the spider is uncarefully touched. The poison released by female spider is many times stronger than that by male spider.
     The Black Widow venom belongs to toxalbumines. It is neurotoxic, spreads through lymphatic system and contains about half a dozen active components with molecular weight values within 5.000 - 130.000 Daltons. It affects membranes of motoric neurons endings in neuro-muscular synapses, which facilitates arrival of Na+ -iones , and causes release of acetylcholine and norepynephrine (adrenalyne rush) in synapses, reducing the rate of reverse chemical reaction. The result of these processes is extra-stimulation in the ganglia of muscular  neurons.
     The bite effected by the female Black Widow causes a complex of symptoms known as LATRODECTISM.

Clinical Pattern & Diagnostics.
     After bite a small spot mark appears which quickly fades. In some minutes at the bite location severe pains arise spreading to limbs, loin, chest, abdomen accompanied with heavy muscles tensions in abdomen (differential diagnostic pattern with "sharp belly"). Weakness, sense of cold, hyperesthesy, excessive sweating, psychomotoric disturbances, hallucinations, Pavor mortis, tremour and fascicular muscular reductions may be also observed as well, as breath difficulties, bronchorhea, nausea, vomitting. Tachicardy, extrasistoly, blood pressure increase are observed, too. Probable acute breath stoppage. 
     Last involved are mimic muscles - sweating, distorted of pain and fear face with apparent blepharoconjunctivite and lacrimation is known as Facies LATRODECTISMICA - Lat. Priapism, urination delays, sense of thirst, salivation, convulsions, alternating speech disfunctions and, very rarely, core-like rash and itching may be observed.
     The symptoms usually last for 24-48 hours, but in cases of severe intoxications even longer - up to few days. In case of delayed treating the signs of astheny, hyposthesy and neuropathy may keep for several months.
     Lethal outcome may occur both in case of children and adults, suffering from some background diseases of in case of late hospitalization and amounts to 4 - 6% of total amount of cases - being a high rate.
     In case of laboratory attendance leicocytosis, hyperglicemia and increased phosphocinase content may display.

Urgent First Aid and Treatment.

1. To burn immediately the location of the bite (using matches).

2. Place cold on the place of location and immobilize the limb.

3. In case of hypertension - 0,15 mg Clophelini.

4. Hospitalization is compulsory both in case of actual and suspected bites.

5. In case of apparent pain syndrome - 2 ml Tramadoli intramuscular or Cetoroli.

6. In case of disturbance - Diasepami / Sibazoni, Seducceni - 2 ml 0,5% solution intravenous

7. Cardiamini - 2 ml intramuscular.

8. Specific anti-Black Widow serum - normal dosage is 1-2 doses dissolved in 500 - 1.000 ml 0,9% NaCl solution intravenously.

9. In cases when anti-Black Widow serum  is unavailable methodics of indirect electrochemical blood oxidation (ECO) may be applied by means of intravenous infusion (only into the main veins !!!) 0,06% Sodium hypochloride solution at a dose of 5 ml/kg of body mass every 8-12 houra prior elimination the clinical pattern of intoxication (the Danube Basin Hospital on the Water Transport, Izmail City, Ukrainian Patent № 2000105761 dated October 11, 2000).

10. Symptomatic therapy.

     The prophylactics complex for the Black Widow bites prevention consists of destruction of the species residing at the private property territories including barn, sheds, yard-built toilets, shadowed corners in garages and barns, baths by means of Creosote or Pyretrins group insecticides of low-toxic nature, made on the base of plants (Camomile, Chrysanteme) sprayed once in three months. During farming activities, such as collecting hay, firewood stowage, etc. it is highly recommended to wear working gloves, closed footwear and corresponding clothes with long sleeves tightly buttoned at the wrists.
Spending time in forests or near lakes, rivers it is necessary to be utmostly careful near the heaps of dried grass and not to walk barefeet through areas with dried grass.  

Telephones for Information / Consultations:
Chief Physician +038 (04841) 25195, 24066
Detoxication Department +038 (04841) 21425
Reception +038 (04841) 20175

Method 1 | Method 2 | Method 3

The Black Widow Bite
"URGENT THERAPY" 
2nd Edition, amended, Odessa 2001.
Dr. Vladimir M. Mavrodiy, Professor, Chair of Family Medicine, Odessa Medical University

1. Immediately burn the bite location (using match or lighter),
2. In case of hypertension - Clofelini 0,15 mg, to chow; afterwards  0,075 mg each 30 minutes up to 6 times
3. In case of pain - Tramadoli, intramuscular 2 ml, or CETOROLAK (CETOROL)
4. DIASEPAM (SIBAZON, SEDUCSEN) intravenous, 2 ml 0,5 % solution,
5. CARDIAMINI, intramuscular 2 ml
6. Anti-Black Widow detoxicating serum under the Bezretko methodology: in easy cases 1 ampule intramuscular, in medium severe cases  - 2-3 ampules intramuscular, in severe cases 5-7 ampules intravenously, 15 prior, inject DIMEDROLI intramuscular 2 ml 1% solution

In cases of bite the patient must be transferred to toxicology department and hospitalized.

Anti-Black Widow Serum

     The unique anti-Black Widow Serum is produced in Uzbekistan (Vaccines & Serum Institute, 37, Maulyanov Str. Tashkent) and is highly efficient. IT s prepared on the base of horse extracts and features the same side effects, as the anti-serpent serum, including Anaphilactic Shock, Allergical Reactions of various nature and types, Serum Disease.
     There is only one official distributor of the Tashkent Institute residing in Kazakhstan - Messrs. "Alua-Medfarm", 534, Seigullin Street, Almaty, Phone: (3272) 62 66 36.
     Normal dosage of the unique serum rates to 1-2 doses, dissolved in  500-1000 ml 0,9% NaCl solution intravenously.
     The symptomatic treatment comprises the essential life-supporting functions, i.e. adequate breathing and cardiovascular activities as well, as blood microcirculation.
     The ice or cold compress, placed on the location of the bite brings certain relief. As pain-releasing aids Salicilates may be used (Aspirin, etc.), non-steroid antiphlogistic aids (Ibuprofeni, etc.) or opioides, since muscular pains are very severe. In the severest cases even intravenous injections of opiates or opioides does not bring complete relief from pain. The most effective is combined application of opiates and opioides with benzodiazepins (Diazepam, Seduxen, Lorazepam) which, in addition to sceletic muscles relaxation possess sedative, amnestic and anxiolitic effects.
     Traditionally, intravenous injections of 10 ml 10% Calcium Gluconate are apply to reduce fasciculatory reductions of muscles and muscular tension. This aid must be introduced at a low rate for 10-15 minutes repeating after 30-40 minutes. The mechanism of Calcium Gluconate action is not sufficiently studied and its application is based on practical experience only.

 Method 1 | Method 2 | Method 3 | SODIUM HYPOCHLORID