QUESTIONS and CONTROVERSIAL ISSUES

I) What are the best pharmaceutical agents available for treating this patient's pain?

• Adequate doses of opioids/morphine
• Calcium gluconate
• Muscle relaxants

II) Is there an antivenin available?

• Antivenin for Black Widow Spider envenomation available in Arizona and Australia
• Harvested from horses

III) What are the indications for its use?

• Extreme intractable pain despite other pharmaceuticals
• Hemodynamic compromise
• Extremes of age (very young and old)

IV) What are the side effects of antivenin administration?

• Allergic/anaphylactic reactions
• Delayed serum sickness

CLINICAL COURSE

Before the patient is rushed to the OR for an exploratory lap R/O acute appendicitis, he is given calcium gluconate and morphine with adequate pain control. He requires no black widow spider antivenin. The patient recovers without sequelae apart from a chronic case of arachnophobia.