{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,8,10]],"date-time":"2024-08-10T23:12:24Z","timestamp":1723331544879},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,2,20]],"date-time":"2018-02-20T00:00:00Z","timestamp":1519084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008476","name":"University of California, Irvine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008476","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Snake envenomation is a neglected global health problem. There is a need for a prehospital treatment of neurotoxic snakebite that prolongs survival and allows time for a victim to reach a hospital for antivenom therapy. Tumescent epinephrine consists of a large volume of dilute epinephrine (2 mg\/l) injected subcutaneously. It functions as \u201ccontravenom\u201d by causing capillary vasoconstriction and delaying venom absorption.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A murine model of neurotoxic envenomation using lidocaine as a surrogate for neurotoxic snake venom was first developed in a pilot study. A lethal dose of lidocaine was injected subcutaneously into control and treatment groups. Mice in the treatment group were then treated with a tumescent infiltration of dilute epinephrine in saline, while control mice either received no treatment or tumescent infiltration with saline alone. The experiment was repeated using lethal doses of neurotoxic <jats:italic>Naja naja<\/jats:italic> cobra venom. The main end\u2010points were survival rate and survival time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>None of the control mice survived a lethal (<jats:styled-content style=\"fixed-case\">LD<\/jats:styled-content><jats:sub>100<\/jats:sub>) dosage of subcutaneous lidocaine. Mice given an <jats:styled-content style=\"fixed-case\">LD<\/jats:styled-content><jats:sub>100<\/jats:sub> of subcutaneous lidocaine and treated immediately with tumescent epinephrine had 80% survival. Following <jats:styled-content style=\"fixed-case\">LD<\/jats:styled-content><jats:sub>50<\/jats:sub> doses of <jats:italic>Naja naja<\/jats:italic> venom, 50% of control mice survived, while 94% survived when treated immediately with tumescent epinephrine (<jats:italic>P<\/jats:italic> &lt; 0.01). All animals died following <jats:styled-content style=\"fixed-case\">LD<\/jats:styled-content><jats:sub>100<\/jats:sub> doses of <jats:italic>Naja naja<\/jats:italic> venom, but survival was significantly prolonged (<jats:italic>P<\/jats:italic> &lt; 0.0001) by immediate tumescent epinephrine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Tumescent epinephrine, when given immediately after toxin injection, improves survival rates in mice following neurotoxic doses of lidocaine or <jats:italic>Naja naja<\/jats:italic> cobra venom.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijd.13877","type":"journal-article","created":{"date-parts":[[2018,2,23]],"date-time":"2018-02-23T18:15:49Z","timestamp":1519409749000},"page":"605-610","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Tumescent contravenom: murine model for prehospital treatment of <i>Naja naja<\/i> neurotoxic snake 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