Cobra bite sets off hunt for antivenin

Experts question account of encounter on White Marsh parking lot

January 28, 2010|By Frank D. Roylance | Baltimore Sun reporter

The arrival of a Baltimore County woman at a White Marsh clinic with a cobra bite to her finger touched off a two-state scramble for antivenin to save her.

Meanwhile, her story - that she had come across the highly poisonous monocled cobra in the parking lot of the White Marsh Mall - immediately raised eyebrows among the snake-savvy.

Experts say the animals, normally found in Southeast Asia, could not survive outdoors in Maryland in January. And finger bites are typical of injuries to careless snake handlers during feeding.

"Our officer is currently investigating the case," said Sgt. Art Windemuth, with the Maryland Natural Resources Police. "There is a state law that prohibits the possession or importation of venomous snakes." Violators face misdemeanor charges and a fine up to $1,000.

The rush to save the woman began shortly after 7 p.m. Sunday, when the Baltimore County Fire Department received a call from the Patient First walk-in clinic in the 4900 block of Campbell Blvd. in White Marsh. The woman, whom authorities have not named, said she had been bitten when she picked up what she thought was a stick.

She had brought the 2-foot-long cobra with her in a bag.

Fire Department spokeswoman Elise Armacost said the patient was sent to Franklin Square Hospital, then to Johns Hopkins. Calls were made to the county health department, Falls Road Animal Hospital and the Maryland Poison Center at the University of Maryland School of Pharmacy in Baltimore.

"Most hospitals in the state of Maryland do have antivenin to treat bites by the kinds of snakes we have in Maryland," said Bruce Anderson, a pharmacist at the center. But the cobra presented "an extraordinary circumstance."

The center staff checked their more exotic lists of antivenin supplies. A batch at the Maryland Zoo in Baltimore had expired.

When poison center staffers located a supply at the Philadelphia Zoo, Pennsylvania police agreed to fly it to Baltimore. But bad weather forced officials to have 10 vials driven 100 miles to Hopkins.

The bite victim reportedly received nine vials, and was released from the hospital on Monday. The 2-year-old snake, described as captive-bred and well cared for, was driven by Natural Resources Police to the Catoctin Wildlife Preserve and Zoo near Frederick. Officials there said it was doing well.

Bites by exotic snakes are rare in the United States, so the antivenins used to save victims are also rare.

"People always get bitten late in the evening or in bad weather. It's a logistical nightmare to transport antivenin in a timely fashion,"said Don Middaugh, curator of reptiles at the Catoctin Zoo

Time can be critical. With cobras, symptoms can appear in 15 minutes, or may be delayed by as much as 12 hours.

But it's impossible to tell how much venom a snake has injected into a victim. Many bites are "dry," with no venom. Doctors wait for symptoms to appear, and give antivenin as needed.Describing snake venom as "one of the most complex cocktails in the world," Middaugh said some components are digestive, killing skin, fat, nerves, muscles and bone near the bite. Antivenin does not prevent such tissue death.

Jim Harrison, director of the Kentucky Reptile Zoo, said the cell damage also produces toxins that cause kidney damage. Victims "end up on dialysis for the rest of their life," he said.

Other chemicals in the venom are neurotoxins, evolved to paralyze prey. They can also stop a human's breathing. The correct antivenin is needed within an hour or two of the bite.

Moving antivenin to bite victims quickly can sometime take heroic measures and can endanger other lives. "Begging me for my antiserum puts me at risk," Harrison said.

Harrison's lab extracts venom from up to 1,000 snakes a week to supply medical researchers around the world. He keeps supplies to protect his staff, and they can cost thousands of dollars to replace. "We have had a couple of years when we have lost $50,000 in antiserum in multiple incidents," he said.

Because they're considered "investigational" drugs, patients can't be charged for their use, and insurance companies will not reimburse the zoo.

Harrison believes ownership of venomous snakes should be strictly regulated, and owners should be required to keep their own antivenin.

"When you play with fire, you're gonna get burned," he said. "The most important thing is to have a fire extinguisher."

Baltimore Sun reporter Liz F. Kay contributed to this article.

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