Lizard bites

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Background

Glia monster.
Mexican Beaded Lizard.
  • 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

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

External Links

See Also

References