More worries from gila monsters

Most know that Gila monsters are the a venomous lizard indigenous to the United States, but typically know very little about them. Of course, most of this has to do with the fact that it has a relatively small range, and that range is sporadically populated. This lack of real knowledge, combined with the fear of any venomous species puts the Gila monster at great risk from the average person who comes across one.

Notwithstanding the fact that most people don’t ever see one of these in the wild, they apparently crawl around the waiting room at ABEM general, so the average emergency doctor should know enough about them to answer one question about them on their board exam. Gila monster bites are strong, and can require great force to get them to release. They produce venom from their lower jaws, and don’t inject the venom but instead chew on the victim to allow more tissue contact. There are reports that they often flip over during chewing, to allow gravity to aid the flow of venom into the wound.

The good news is that while the Gila monster does produce a venom as toxic as the western diamondback, it produces very little of this venom. In fact, no deaths have been reported in more than 70 years. There are a number of other proteins in the venom, including a glucagon-like peptide that has been synthesized and released as a treatment for diabetes under the generic name exenatide.

This case report, however, doesn’t involve the venomous aspect of the gila monster. It describes the clinical course of a 40 yr old gentleman who captured the lizard by covering it with a box, then was bitten upon removing the box. Approximately 30 min later, he developed fullness of the throat. He presented to the ED 1 hour after the bite with symptoms consistent with anaphylaxis. He of course had been drinking for “several hours” prior to the injury. Standard anaphylaxis treatment was given, and the patient did well.

The part of the paper worth the price of admission though? This quote from Smith RL: Venomous Animals of Arizona. Tucson, University of Arizona, 1982, pp 100-104.

Suggested methods to remove a Gila monster have included placing a strong stick in the back of the lizard’s mouth and pushing; the application of an open flame to the underside of the animal’s jaw; immersion of the extremity (and lizard) in water; and the rather unwise suggestion of grasping the lizard by the tail and jerking it from the bite

The paper goes on to describe the components of Gila monster venom mainly to explain that it is unlikely that the cause of the constellation of symptoms is anything but anaphylaxis.

It is remarkable how little has changed in the treatment of anaphylaxis in the 27 years since this paper was published. Thankfully we don’t give epinephrine subcutaneously for this condition anymore, and probably overdo it with the H2 blockers, but otherwise we haven’t messed with the relatively cheap and effective treatment we have.

Piacentine J, Curry SC, Ryan PJ. Life-threatening anaphylaxis following gila monster bite. Ann Emerg Med. 1986 Aug;15(8):959-61. [PMID 3740587]