Almost all patients develop oliguria or anuria within a few hours to as late as 6 days post bite. The advanced saliva mixtures that lead to various painful venoms has placed venomous snakes into unique categories of their very own. The Viperidae are a family of venomous snakes commonly referred to as vipers.  Some reports suggest that this species produces a large amount of venom that is weak compared to some other vipers. The Chinese cobra (Naja atra) is a highly venomous member of the true cobras (genus Naja). This makes it difficult to obtain venom in useful quantities and good condition for study purposes. are also commonly included in the Elapidae family. It does not usually spread a hood nor hold up its body up off the ground like true cobras do. Coral snakes are relatively docile, but will respond aggressively if disturbed, delivering a pugnacious bite. Envenomation results in marked local effects such as pain, severe swelling, bruising, blistering, and necrosis. Its venom contains primarily taicatoxin, a highly potent neurotoxin known to cause hemolytic and coagulopathic reactions. The LD50 of this species is 2 mg/kg SC and 1.15 mg/kg IV.  Hemorrhagins may be present in the venom, but any corresponding effects are completely overshadowed by the startling and serious neurotoxic symptoms. The anti-MPE was also moderately effective in the neutralization of other Naja venoms (Naja kaouthia, Naja nivea). This is the only rattlesnake species in most of the populous northeastern United States and is second only to its cousins to the west, the prairie rattlesnake, as the most northerly distributed venomous snake in North America. Some evidence suggests that pressure and immobilization of the wound area until antivenin can be administered is beneficial for the outcome of elapid bites.  A death adder can go from a strike position, to strike and envenoming their prey, and back to strike position again, in less than 0.15 seconds.  The average murine LD50 value of this species is 1.15 mg/kg IV, but there is an IV LD50 range of 0.97 mg/kg-1.45 mg/kg.  The LD50 in mice is 0.47 mg/kg and the average venom yield per bite is 18 mg (dry weight of milked venom) according to Meier and White (1995). The majority block ACh transmission by competitively binding to the postsynaptic nicotinic and muscarinic ACh receptors or by presynaptic inhibition of ACh release, which prevents muscle contraction.183,184 The better-known examples of neurotoxins that interrupt postsynaptic binding are krait α-bungarotoxin and naja cobrotoxin (Figure 43-7).  Brown (1973) gives the following LD50 values for mice: 1.5 mg/kg IV, 1.6–6.2 mg/kg IP, 6.0 mg/kg SC. 1996 list a value of 0.225 mg/kg SC. This color pattern can be best remembered by the warning that if caution (yellow) touches danger (red), the snake is a coral snake.  At least one antivenom protects specifically against bites from this species: India Antiserum Africa Polyvalent. It is a polypeptide analogous to the human atrial natriuretic peptide; it is responsible for causing diuresis through natriuresis and dilating the vessel bloodstream, which results in, among other things, acceleration of venom distribution in the body of the victim, thereby increasing tissue permeability. Two genera are indigenous to the United States. These toxins may result in local tissue destruction and a consumptive coagulopathy. The spitting cobras include the Indo-Chinese spitting cobra (N. siamensis), the Sumatran spitting cobra (N. sumatrana), N. sputatrix, and N. mandalayensis (Warrell, 2010b). Bites by coral snakes are relatively rare. , The proteins in black mamba venom are of low molecular weight, low viscosity, and the venom's high activity in terms of hyaluronidases, which is also essential in facilitating dispersion of venom toxins throughout tissue (spreading the venom through the body) by catalyzing the hydrolysis of hyaluronan, a constituent of the extracellular matrix (ECM), hyaluronidase lowers the viscosity of hyaluronan, and Dendroaspin natriuretic peptide (DNP), a newly discovered component of mamba venom, is the most potent natriuretic peptide and is unique to the genus Dendroaspis, or mambas. But unlike some other members of the family Elapidae (the species of the genus Bungarus, genus Oxyuranus, genus Pseudohaje, and especially genus Dendroaspis), half of the bites by many species of both African and Asian origin of the genus Naja are "dry bites" (a dry bite is a bite by a venomous snake in which no venom is released). Pit vipers are the snakes of most concern in North America. Snakes produce some of the most varied neurotoxins in the animal kingdom. Suzanne Donahue VMD, DACVECC, Deborah C. Silverstein DVM, DACVECC, in Small Animal Critical Care Medicine (Second Edition), 2015, Bites from Elapidae family of snakes (e.g., cobras, mambas, and tiger snakes), including the Eastern coral snake (Micrurus fulvius fulvius) in the southeastern United States and the Texas coral snake (M. f. tenere) in Texas, Louisiana and Arkansas, also lead to lower motor neuron disease. However, in 2008, around the area of Friguiagbé in Guinea, there were 375 bites attributed to the forest cobra and of those 79 were fatal.
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