American family physician
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American family physician · Oct 2009
ReviewEnvenomations: an overview of clinical toxinology for the primary care physician.
About 4,000 to 6,000 venomous snakebites occur each year in the United States. Although these envenomations (also known as envenomings) are rarely fatal, about 70 percent require antivenom therapy. Few evidence-based guidelines are available for the management of envenomation. ⋯ Conversely, little evidence supports any specific management strategy for necrotic envenomation from recluse spiders. Cytotoxic fish stings, cnidarian stings, and traumatic penetrative envenomation by stingrays are typically managed symptomatically. Private collection of nonnative venomous animals in the United States is another source of medical risk.
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Henoch-Schönlein purpura is an acute, systemic, immune complex-mediated, leukocytoclastic vasculitis. It is characterized by a triad of palpable purpura (without thrombocytopenia), abdominal pain, and arthritis. Most patients have an antecedent upper respiratory illness. ⋯ Early aggressive therapy with high-dose steroids plus immunosuppressants is recommended for patients with severe renal involvement. Long-term prognosis depends on the severity of renal involvement. End-stage renal disease occurs in 1 to 5 percent of patients.