Fatal brown snake (Pseudonaja textilis) envenomation despite the use of antivenom.

OBJECTIVE: To report two cases of fatal brown snake envenomation in adults despite the use of appropriate antivenom. CLINICAL FEATURES: Two men, aged 42 and 39, one with a history of hypertension, suffered fatal brown snake envenomation in Queensland. One believed he had been stung by a wasp. Both developed cardiorespiratory failure within one hour of the bite, followed by coagulopathy and pulmonary oedema. One patient developed fulminant multiorgan failure. INTERVENTION: Both patients died despite the administration of large doses of appropriate antivenom and full supportive care.
CONCLUSION: Brown snake bites remain extremely dangerous despite the availability of specific antivenom. In severe cases associated with myocardial depression and gross coagulopathy, death may occur rapidly despite the use of conventional doses of antivenom. In such patients the antivenom requirement may be much greater than is currently recommended.