Work

Severe Sydney funnel-web spider envenomation in a toddler: a case report

Year: 2026

Type: article

Abstract: Introduction Sydney funnel-web spider (Atrax robustus) envenomation produces overlapping catecholaminergic and cholinergic toxidromes that can progress rapidly to life-threatening cardiorespiratory compromise. Airway management in this setting carries unique pharmacodynamic challenges.Case A 2-year-old boy developed refractory generalised seizures, severe trismus, hypoxic and hypercapnic respiratory failure, and cardiogenic pulmonary oedema following a Sydney funnel-web spider bite. Seizures persisted despite two doses of midazolam. Rapid sequence intubation was complicated by prolonged trismus, consistent with the delayed onset of neuromuscular blockade in the setting of venom-induced excess synaptic acetylcholine. One vial of antivenom and supportive care resulted in full recovery without residual deficit.Discussion The persistent trismus likely reflected a combination of ongoing seizure activity, direct neuromuscular excitation, and competitive antagonism of rocuronium by excess acetylcholine. Clinicians managing funnel-web envenomation should anticipate these interactions and consider higher doses or alternative neuromuscular blocking agents.

Source: Toxicology Communications

DOI: 10.1080/24734306.2026.2740880

Authors: Pramod Chandru, Joshua Stephenson

Institutions: Nepean Hospital, Camden and Campbelltown Hospitals

Language: English

Topic: Venomous Animal Envenomation and Studies

Subfield: Genetics

Field: Biochemistry, Genetics and Molecular Biology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $778