The National Poison Centre is the only centre in the country that serves health professionals and the public on chemical safety and poisoning related information, including venomous bites.

What is the role of the National Poison Centre (NPC) and what part does it play in emergency cases such as poisoning or bites by poisonous creatures and insects?

Adilah Mohamed Ariff, senior pharmacist and head of Service Call Centre Unit at the National Poison Centre, Universiti Sains Malaysia, Penang, gives us more insight about the centre’s services.

The King cobra belongs to the Elapidae family. Identification of the snake may help to save the bite victim’s life as appropriate antivenom can be given immediately.

Does the National Poison Centre provide antivenom to state hospitals to treat cases involving bites by poisonous creatures (venomous snakes) and insects (wasps, jellyfish stings)?

The National Poison Centre does not stock/develop/import any antivenom, but it facilitates enquiries on availability of antivenom in Malaysian hospitals.

We have a database on the availability of antivenom based on information provided by pharmacists in local hospitals.

Hospitals do not import antivenom directly but purchase them from local pharmaceutical companies licensed by the Health Ministry to import the antivenom from manufacturers.

In the absence of antivenom, an anti-tetanus jab ALONE is not sufficient because both have different functions. Antivenom neutralise venom while anti-tetanus jab prevents and treats tetanus, (a.k.a. lockjaw), a serious bacterial infection.

In Malaysia, what are the typical (common) poisonous snake bites?

Based on epidemiological studies in Malaysia, the Malayan pit viper, cobra, shore pit viper and Wagler’s pit viper are the four commonest species of snakes associated with snake bite envenomation.

However, there are also many cases where the snake was unknown as victims can’t see the features clearly.

It’s important to see as much as possible the physical appearance of the snake even though we can’t identify it by name. Remember the shape of the head and the colour of the body as these details may be helpful to identify the possible type of the snake and to differentiate between the venomous and non-venomous snake.

Identification of the snake may help to save the bite victim’s life as appropriate antivenom can be given immediately.

There are three common families of venomous snakes in Malaysia:

> Elapidae family – cobra, King cobra, kraits, coral snakes.

> Crotalidae family – Malayan pit viper, shore pit viper.

> Hydrophidae family – most of the sea snakes.

What should be done in an emergency?

Do’s

1. Phone or send for medical assistance.

2. Reassure the the victim who may be very anxious and encourage him/her to remain calm.

3. Have the victim remain as still as possible. Do not attempt to catch or kill the snake.

4. Immobilise the bitten limb with a splint or sling because movement or muscular contraction increases absorption of venom into blood and lymphatics.

5. Apply a pressure bandage to the envenomed limb. If the bite is to the trunk, apply firm pressure to the bitten area.

The only universally accepted bandage technique is recognised as “pressure immobilisation bandage (PIB)”.

This technique is done by putting splint and bandage with a “not so light and not so hard” pressure. However, if the type of snake is unknown or the rescuer is not familiar with PIB, simply help the patient to remain still as much as possible while seeking medical assistance.

Pressure immobilisation method may prevent or delay the development of life-threatening paralysis from cobra, king cobra, kraits and sea snake bites.

Ideally, an elastic, stretchy crepe bandage about 10 cm wide and 4.5 metres long should be bound firmly around the entire bitten limb, starting distally around fingers or toes and moving proximally, to include a rigid splint too. It should not be too tight that the peripheral pulse is occluded or that a finger cannot easily slip between its layers.

Important: Pressure immobilisation is recommended for bites by neurotoxic elapid snakes including sea snakes, but should not be used for bites by vipers whose venoms cause local necrosis.

6. Remove any items or clothing which may constrict the bitten limb if it swells (rings, bracelets, watches, footwear, etc).

7. Avoid any interference with the bite wound as this may introduce infection, increase absorption of the venom and increase local bleeding. If there is any bleeding on the bite site, hold a clean cloth/cotton on the area for about 5 minutes until the blood stop.

8. Where possible, help should be brought to the patient rather than moving the patient.

Don’ts

1. Do not apply any traditional or even modern topical cream/lotion/ointment.

2. Do not tie or apply tourniquet at any part of the limb because it may cause venom to deposit in one area, causing more complications like compartmental syndrome and/or disability.

3. Do not incise the bite site.

4. Do not suck the venom with any method.

5. Do not apply hard pressure on the bitten area.

7. Do not give the victim anything to eat or drink, especially consumable alcohol that may accelerate absorption of venom.

8. Do not administer stimulants or pain medications to the victim, unless specifically directed by a physician.

What if a person is bitten by a cobra on the neck?

The same emergency measures can be taken as a bite on other parts of the body; minimise movement and seek medical assistance as soon as possible.

Are there cases of tarantula or other poisonous animal bites?

To date, no tarantula bite cases have been referred to the NPC. However, other unknown type of spider bite cases have been referred as well as bites by scorpion, centipede, bee, wasp, ant, and marine poisonous creatures like jellyfish, puffer fish, catfish, red snapper and red tide (harmful algal bloom).

Based on an unpublished study in 1999-2001, the actual number of cases admitted to government hospitals due to animal toxins exposure outnumber poisoning cases involving chemical agents.

However, very few animal bites cases were referred to NPC.

What is the role of the National Poison Centre with regards to assistance given to public, private hospitals and the public?

Its Drug and Poison Information Services (DPIS) is available to the public and health professionals 24 hours a day, seven days a week. E-mail enquiries are also entertained from time to time. NPC can be consulted on:

> Acute and chronic poisoning involving drugs and medicals products, pesticides, household products, industrial chemicals and natural toxins.

> Misuse and abuse of medicines/drugs.

> Drug-related problems, including adverse reactions.

Currently, the DPIS is fully utilised by health professionals from government health facilities, with an increasing number of poisoning cases referred for enquiries every year. Enquiries from private hospitals and the public are still very few since not many poisoning cases are admitted to private hospitals and most Malaysians will normally send poisoned patients to hospitals rather than call the NPC beforehand.

NPC also assists health professionals and public in dealing with poisoning cases through prevention, education and training programmes. Laboratory analysis is also available for them to identify poison in products or biological sample.

> The National Poison Centre 24-hours Drug and Poison Information Service – (Monday-Fridays: 8.10am–5.10pm): 04-657 0099 or 1800-88-8099; after-office hours (weekends & public holidays): 012-430 9499; website: www.prn.usm.my

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