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Use of neostigmine - atropine plus antivenom in the experimental envenomation by Micrurus venom. Preliminary results.
* 1, 2 , 2 , 2 , 1 , 1 , 2
1  Área Investigación y Desarrollo – Venenos, Instituto Nacional de Producción de Biológicos, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud y Desarrollo Social, Argentina.
2  Primera Cátedra de Toxicología, Facultad de Medicina, Universidad de Buenos Aires, Argentina.

Published: 13 January 2021 by MDPI in 1st International Electronic Conference on Toxins session Poster

Venoms of most elapids are neurotoxic being their most important components alpha-neurotoxins and PLA2s. The treatment with neostigmine and atropine(NA) has been suggested to revert the toxicity of nicotinic toxins. The usefulness of an alternative tool is very important due to the lack of antivenom for some Elapids like Micrurus(M.), due the scarcity of specific antivenoms (AV). We assayed in rescue experiments (mice challenged with mortal doses) the usefulness of the combination neostigmine–atropine (NA) alone or combined with AV. The venoms of Naja (N.) kaouthia, M. altirostris, M. pyrrhocryptus and M. surinamensis. The Antivenom used were therapeutic anti-Micrurus and experimental anti-Naja siamensis antivenoms. Despite that all the cases received a single dose of 20 μg atropine + 2.5μg neostigmine by i.p. route delayed the time of death (p<0.05), no good protection was observed using only this treatment. In the other hand, only high doses of AV achieve some level of protection. Nevertheless the combination of NA plus AV, reduced the mortality, as well as the dose of antivenom required for protection in all the cases regarding these treatments used alone. In the case of M. altirostris venom, the protection using NA was from 0 to 20% and that using 50 μl of AV ranged from 0 to 60%, while using the combined treatment the protection was from 80 to 100% (p 0.046 and 0,02 regarding AV or NA alone). In the other cases an improvement was observed regarding the uses of NA alone, AV alone (250 μl) or their combination. In the case of N. kaoutia= 0%, 20%, 40% respectively, M. pyrrhocryptus= 0%, 60%, 100% and M. surinamensis= 0%, 0 to 20%, 40-80%. These preliminary results suggest the utility of this combination for the treatment of these envenomations, which could be helpful to reduce the dose of AV.

Keywords: Elapids: Micrurus: Neostigmine; Atropine; Envenomation; Antivenom; Treatment