Everyone has a snake story. Dr. Ziad Kazzi has more than most. As one of only four toxicologists in Alabama, the ER physician sees many of the snakebite and poisoning cases that come to UAB and Children’s Hospital. He’s also likely to be the voice on the other side of the phone when physicians from across the state call the poison control center for a consultation on difficult cases.
“Alabama has one of the largest varieties of snakes in the country. Fortunately, only four types are poisonous,” said Kazzi. “Most bites are from pit vipers — copperheads, rattlesnakes and cotton mouths. Coral snakes are less common.”
Since warm weather brings out both snakes and people wanting to enjoy the outdoors or looking for a cool, shady spot to escape the heat, that’s when most bites occur.
“We had a lady from Mountain Brook who was gardening and accidentally picked up a copperhead when she was clearing debris,” said Kazzi. “A teacher was also bitten in a school closet when a snake came out of furniture stored there.”
Snakes tend to avoid crossing paths with humans whenever possible. They are deaf, but can sense vibration, so tramping through the woods in big boots to make sure they know you’re there is a good policy.
Occasionally bites come not so much from accidental encounters as from dubious judgment. Someone who wants a snakeskin belt might not underestimate how unwilling the snake is to part with it.
“We also had a case where a man caught a rattlesnake and kept it in a bucket overnight. The next morning, when he took the cover off, he poked it to see if it would move. It did,” said Kazzi.
“In this area, more bites are from copperheads. Although there can be local tissue damage and complications, their bites usually aren’t as serious,” he said. “Rattlesnakes can be more dangerous. Their venom can cause systemic problems, seizures, paralysis, low blood pressure and circulatory symptoms.”
Only about half the hospitals in Alabama keep antivenin on hand, though they can usually obtain supplies quickly when needed. In serious cases, patients may need six vials of the $1,000 per vial antidote. Physicians in outlying areas often consult with Kazzi by phone when making treatment decisions.
“Some bites are dry, with little or no venom injected. Patients may only need observation,” said Kazzi. “However, if there is a progression of swelling, signs of coagulation problems or other systemic symptoms, the patient is likely to need antivenin. We use the same type for all pit vipers, since their venoms are cardiotoxins. Fortunately, in the two years I’ve been here, I haven’t had to use the antivenin for the neurotoxin in a coral snake bite. “
Now that more exotic animals are being kept in homes as well as zoos, poisonous pets may bite the hands that feed them. Kazzi has also treated patients who have had painful encounters with spiders and a stingray.
“Black widow spiders are more common than people realize, and their bite can be lethal. You often find them outside hiding under debris. We also have a lot of brown recluse spiders in the area, usually in basements. There isn’t much we can do for those patients except deal with the necrosis in the tissue.”
Kazzi studied at the America University of Beirut Medical School in his native Lebanon before coming to Emory to train in emergency medicine. While there, he completed a fellowship in medical toxicology with the CDC in Atlanta. After 9/11, he used his medical toxicology and ER training in the federal terrorism preparedness program. He continues to be a guest researcher with the radiation branch at the CDC, where he studied a drug for the treatment of acute radiation syndrome.
As part of Kazzi’s interest in community environmental health and public health preparedness, he often works with EMS and hazmat teams. He is now conducting a series of 12 blast injury seminars across the state to train first responders in issues they are likely to face following explosions.
In addition to being an assistant professor in the department of emergency medicine at UAB, Ziad is assistant medical director for the Alabama Poison Control Center and a consultant for the Regional Poison Control Center.
“This time of year, we also get calls about poison mushrooms, which can be deadly,” said Kazzi. “There are occasional deliberate poisonings, like the woman who argued with her boyfriend about making chicken salad. She spiced it with pesticide and said it was the last chicken salad she would ever make him.“
Sometimes it pays to tread carefully even when there are no snakes around.
July 2007
