Terrestrial Envenomations in Pediatric Patients: Identification and Management in the Emergency Department

Points and Pearls Excerpt

• Envenomation by Latrodectus mactans (black widow spiders) can result in significant pain and hyperadrenergic symptoms. Treatment should first be focused on ensuring adequate administration of opioids and benzodiazepines.
• Use of Latrodectus antivenom is generally not considered first-line therapy because of the relatively high rate of immediate (anaphylactoid) or delayed (serum sickness) allergic reactions.
• Because toxicity from Loxosceles (brown recluse) bites primarily manifests as necrotic dermal lesions, various soft-tissue infections are often incorrectly ascribed to envenomation from this spider.
• Patients envenomated by a Loxosceles spider should be observed for necrotic lesions and systemic effects. Hemolysis should be treated with corticosteroids.
• Massive hymenoptera envenomation can result in multisystem organ involvement. Treatment with corticosteroids is indicated even though the reaction is not IgE-mediated.