Black Widow Spider


PDA Clinician @ Large
by Grant E. Fraser, MD


A 46 year old female presented to the ER in severe pain. The history is
that she was on her property doing a little cleaning, felt something on her left leg, thought
something might have bit her, didn't see anything. About 1 hour later, her Left leg
started going into spasm, then her abdomen, her Right leg and now extending into her
chest. She was in severe distress.

I knew what was going on as I'd seen this a few times in the past. This was fairly classic
neurotoxin effects of significant widow spider envenomation. Patients may present with
symptoms compatible with acute abdomen or chest pain, depending upon the site of the
envenomation.

I like reviewing content on this condition and used ER Suite's Clinical Consult section that
also includes envenomations.

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The patient's presentation was certainly compatible with this diagnosis. Interestingly, I'd
just done the content update for ER Suite 6.0 on this topic and had found that there have
been some updates to recommendations for treatment of this condition. That being that
narcotics are probably first line, with adding some diazepam and that calcium probably
makes no significant benefit.

This patient did very well with some narcotics and diazepam and within 10 minutes of
being medicated was extremely comfortable. She had no evidence of complications and
was stable for discharge with some narcotics and diazepam after being observed for a
couple of hours.