Looks like I’ve made a lot of new friends here across med/pharm/bio/eco! I’m Thom Mack, a Clinical Toxicologist☠️ & EM PharmD in the SW🏜️. During ☠️-fellowship I was fascinated by rattle-🐍s & stayed for a 2nd fellowship in 🐍 envenoming. So let’s talk about SNAKES! #MedSky #ToxSky #RxSky - ThreadSky

thommytox.bsky.social • 107 days ago

Looks like I’ve made a lot of new friends here across med/pharm/bio/eco!

I’m Thom Mack, a Clinical Toxicologist☠️ & EM PharmD in the SW🏜️. During ☠️-fellowship I was fascinated by rattle-🐍s & stayed for a 2nd fellowship in 🐍 envenoming.

So let’s talk about SNAKES! #MedSky #ToxSky #RxSky

Comments

perthreptile.bsky.social•106 days ago

@thommytox.bsky.social do you get to work with any Aussie snakes? I LOVE venom and its complexity and how it can be used in positive ways, but my small Aussie brain can’t understand most of it 🤣
I keep dozens of Aussie elapids here. Unfortunately there is no call for keepers to work with venom here

queerpharmacist.bsky.social•106 days ago

Good to see you here!

thommytox.bsky.social•106 days ago

Great to be here!

bellewerx.bsky.social•106 days ago

I've never seen a better gif use in my life.

starmd.bsky.social•106 days ago

As a recent transplant to the SW who saw her first rattlesnake on a hike a couple of months ago, this is interesting stuff to know!

thommytox.bsky.social•106 days ago

I’m glad you enjoyed! I will try to add more tox or envenomation things every now and again. I always encourage questions/curiosity!!!

pyslexicdharmacist.bsky.social•106 days ago

Fascinating stuff, I had to look up "myokymia." Which is pretty mild compared to, say, anaphylaxis.

thommytox.bsky.social•106 days ago

Shared with permission, is a good example of myokymia from a rattle-🐍 envenomation. It started in the thigh & spread to the groin, buttocks… the entire leg, persisting for ~48hrs. Indeed was quite a discomfort/painful experience requiring large doses of opioids, benzos, & skeletal muscle relaxants.

thommytox.bsky.social•106 days ago

Besides the pain, it can produce significant rises in CK leading to rhabdomyolysis.

In this video here from “Venom ER”, Sean Bush has a patient with myokymia head to toe.

https://m.youtube.com/watch?v=2UQOP23NDmQ

pyslexicdharmacist.bsky.social•106 days ago

Holy shit, I take that back, my quick google search led me to believe it was just twitching.

thommytox.bsky.social•106 days ago

I know it’s crazy, right?!?!

thommytox.bsky.social•107 days ago

First things first: I’m from the North East originally, we had squirrels & chipmunks not rattle-🐍 & 🦂s. I was initially terrified, but I eventually came around thanks to the help from my herpetology buddy Dan.

Pic: Me & Dan holding a western diamond-backed thicc-boi 🐍

thommytox.bsky.social•107 days ago

Rattle-🐍 envenoming produces a number of clinical consequences. Below are some of the more common findings. But who gets what symptoms or combination thereof???

thommytox.bsky.social•107 days ago

Well, there’s a multitude of toxins found in rattle-🐍 venom that can cause different toxicities in humans. (below by Calvete et al PMID: 19371136). However, expression of venom makeup not only varies between different species of 🐍s but also within a particular specie of 🐍s!

thommytox.bsky.social•107 days ago

What caught my attention was the profound hemotoxicity that came in a variety of combinations of thrombocytopenia, hypofibrinogenemia, elevated PT/INR, or anemia (Hemoglobin). Often above/below the limit of the laboratory detection threshold!

thommytox.bsky.social•107 days ago

Our gang took a look at delayed, recurrent, & persistent coagulopathy (thrombocytopenia, hypofibrinogenemia) in those treated with Fab vs Fab2. What was interesting, of those who were treated with Fab2, none of them developed late hypofibrinogenemia! PMID:35413335

thommytox.bsky.social•107 days ago

As time went by and my experience with treating these patients grew, I noticed something… noticing after a certain amount of antivenom, a pattern of fibrinogen recovery seemed to be present… but what exactly was it?!?!

punyulada.bsky.social•106 days ago

I highly considered going into toxicology (on either the pharm or med side; I did both pharmacy and med school,) but ended up in a different research area instead!

My mother is deathly afraid of snakes, but what got me into toxicology is learning about the Haber-Weiss reaction.

thommytox.bsky.social•106 days ago

I love tox and glad I found it!!!

punyulada.bsky.social•106 days ago

I have no idea why my original reply kept failing to send, but thank you very much for sharing your research (especially in an easy to digest way.)

Are you fine with me sharing a link to your thread with friends?

thommytox.bsky.social•106 days ago

Absolutely!

punyulada.bsky.social•106 days ago

Thank you very much!

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