Phoneutria
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''Phoneutria'' is a
genus Genus (; : genera ) is a taxonomic rank above species and below family (taxonomy), family as used in the biological classification of extant taxon, living and fossil organisms as well as Virus classification#ICTV classification, viruses. In bino ...
of
spider Spiders (order (biology), order Araneae) are air-breathing arthropods that have eight limbs, chelicerae with fangs generally able to inject venom, and spinnerets that extrude spider silk, silk. They are the largest order of arachnids and ran ...
s in the
family Family (from ) is a Social group, group of people related either by consanguinity (by recognized birth) or Affinity (law), affinity (by marriage or other relationship). It forms the basis for social order. Ideally, families offer predictabili ...
Ctenidae. They are mainly found in northern South America, with one species in Central America. Members of the genus are commonly referred to as Brazilian wandering spiders. Other English names include armed spiders (''armadeiras'' in
Brazilian Portuguese Brazilian Portuguese (; ; also known as pt-BR) is the set of Variety (linguistics), varieties of Portuguese language native to Brazil. It is spoken by almost all of the 203 million inhabitants of Brazil and widely across the Brazilian diaspora ...
) and banana spiders (a name shared with several others).


Description

The spiders in the genus can grow to have a leg span of . Their body length ranges from . While some other araneomorph spiders have a longer leg span, the largest ''Phoneutria'' species have the longest body and the greatest body weight in this group. The genus is distinguished from other related genera such as '' Ctenus'' by the presence of dense prolateral scopulae (a dense brush of fine hairs) on the
pedipalp Pedipalps (commonly shortened to palps or palpi) are the secondary pair of forward appendages among Chelicerata, chelicerates – a group of arthropods including spiders, scorpions, horseshoe crabs, and sea spiders. The pedipalps are lateral to ...
tibiae and tarsi in both sexes. ''Phoneutria'' are easily confused with several other non-medically significant ctenids, especially '' Cupiennius'', in which the recently described ''C. chiapanensis'' also has bright red hairs on the
chelicerae The chelicerae () are the arthropod mouthparts, mouthparts of the subphylum Chelicerata, an arthropod group that includes arachnids, horseshoe crabs, and sea spiders. Commonly referred to as "jaws", chelicerae may be shaped as either articulated ...
. Additionally, some ''Phoneutria'' species lack red hairs on the chelicerae, making it an unreliable identification feature. The presence of a dark linear stripe or stripes on the frontal (dorsal) palps and the presence of a single thin black line running anterior-posterior along the dorsal carapace may help identify ''Phoneutria''. Other features are the strong ventral marking on the underside of the legs with contrasting dark mid-segments and lighter joints, and the pattern on the ventral (underside) of the abdomen with several rows of black dots, or an overall reddish color. The characteristic defensive posture with frontal legs held high is an excellent indicator to confirm a specimen is ''Phoneutria'', especially alongside correct color patterns. During the defensive display the body is lifted into an erect position, the first two pairs of legs are lifted high (revealing the conspicuous black/light-banded pattern on the leg underside), while the spider sways from side to side with hind legs in a cocked position.


Taxonomy

The genus ''Phoneutria'' was started by
Maximilian Perty Josef Anton Maximilian Perty (17 September 1804, Ornbau – 8 August 1884, Bern) was a German naturalist and entomologist. He was a professor of zoology and comparative anatomy at the University of Bern. Perty placed two species in the genus: ''Phoneutria rufibarbis'' and ''Phoneutria fera''. The former is treated as a ''
nomen dubium In binomial nomenclature, a ''nomen dubium'' (Latin for "doubtful name", plural ''nomina dubia'') is a scientific name that is of unknown or doubtful application. Zoology In case of a ''nomen dubium,'' it may be impossible to determine whether a ...
''; the latter is the
type species In International_Code_of_Zoological_Nomenclature, zoological nomenclature, a type species (''species typica'') is the species name with which the name of a genus or subgenus is considered to be permanently taxonomically associated, i.e., the spe ...
of the genus.


Species

, the
World Spider Catalog The World Spider Catalog (WSC) is an online searchable database concerned with spider taxonomy. It aims to list all accepted families, genera and species, as well as provide access to the related taxonomic literature. The WSC began as a series of ...
accepted the following species: *'' Phoneutria bahiensis'' Simó & Brescovit, 2001 – Brazil *'' Phoneutria boliviensis'' ( F. O. Pickard-Cambridge, 1897) – Central, South America *'' Phoneutria depilata'' (Strand, 1909) – Guatemala, Honduras, Nicaragua, Costa Rica, Panama, Colombia, Ecuador *'' Phoneutria eickstedtae'' Martins & Bertani, 2007 – Brazil *''
Phoneutria fera ''Phoneutria fera'' is a species of spider with medically significant venom in the family Ctenidae found in South America (Colombia, Ecuador, Peru, Brazil, Suriname, and Guyana). It is commonly known as the Brazilian wandering spider and the bana ...
'' Perty, 1833 (
type Type may refer to: Science and technology Computing * Typing, producing text via a keyboard, typewriter, etc. * Data type, collection of values used for computations. * File type * TYPE (DOS command), a command to display contents of a file. * ...
) – Colombia, Ecuador, Peru, Brazil, Suriname, Guyana *'' Phoneutria keyserlingi'' (F. O. Pickard-Cambridge, 1897) – Brazil *''
Phoneutria nigriventer ''Phoneutria nigriventer'' is a species of medically-significant spider in the family Ctenidae, found in the Southern Cone of South America (Brazil, Uruguay, Paraguay, and Argentina). Along with other members of the genus, they are often referre ...
'' ( Keyserling, 1891) – Brazil, Uruguay, Paraguay, Argentina *'' Phoneutria pertyi'' (F. O. Pickard-Cambridge, 1897) – Brazil *'' Phoneutria reidyi'' (F. O. Pickard-Cambridge, 1897) – Colombia, Venezuela, Peru, Brazil, Guyana


Behaviour

Wandering spiders are so-called because they wander the jungle floor at night, rather than residing in a lair or maintaining a web. During the day they hide inside
termite Termites are a group of detritivore, detritophagous Eusociality, eusocial cockroaches which consume a variety of Detritus, decaying plant material, generally in the form of wood, Plant litter, leaf litter, and Humus, soil humus. They are dist ...
mounds, under fallen logs and rocks, and in
banana A banana is an elongated, edible fruit – botanically a berry – produced by several kinds of large treelike herbaceous flowering plants in the genus '' Musa''. In some countries, cooking bananas are called plantains, distinguishing the ...
plants (hence the "banana spider" nickname) and
bromeliad The Bromeliaceae (the bromeliads) are a Family (biology), family of monocot flowering plants of about 80 genera and 3700 known species, native mainly to the Tropics, tropical Americas, with several species found in the American subtropics and on ...
s. ''P. nigriventer'' is known to hide in dark and moist places in or near human dwellings. ''P. nigriventer'' mates during the dry season from April to June, leading to frequent observations of the species.


Distribution

''Phoneutria'' are found in forests from
Costa Rica Costa Rica, officially the Republic of Costa Rica, is a country in Central America. It borders Nicaragua to the north, the Caribbean Sea to the northeast, Panama to the southeast, and the Pacific Ocean to the southwest, as well as Maritime bo ...
southwards throughout South America east of the
Andes The Andes ( ), Andes Mountains or Andean Mountain Range (; ) are the List of longest mountain chains on Earth, longest continental mountain range in the world, forming a continuous highland along the western edge of South America. The range ...
including
Colombia Colombia, officially the Republic of Colombia, is a country primarily located in South America with Insular region of Colombia, insular regions in North America. The Colombian mainland is bordered by the Caribbean Sea to the north, Venezuel ...
,
Venezuela Venezuela, officially the Bolivarian Republic of Venezuela, is a country on the northern coast of South America, consisting of a continental landmass and many Federal Dependencies of Venezuela, islands and islets in the Caribbean Sea. It com ...
, the
Guianas The Guianas, also spelled Guyanas or Guayanas, are a geographical region in north-eastern South America. Strictly, the term refers to the three Guianas: Guyana, Suriname, and French Guiana, formerly British Guiana, British, Surinam (Dutch colo ...
,
Ecuador Ecuador, officially the Republic of Ecuador, is a country in northwestern South America, bordered by Colombia on the north, Peru on the east and south, and the Pacific Ocean on the west. It also includes the Galápagos Province which contain ...
,
Peru Peru, officially the Republic of Peru, is a country in western South America. It is bordered in the north by Ecuador and Colombia, in the east by Brazil, in the southeast by Bolivia, in the south by Chile, and in the south and west by the Pac ...
,
Bolivia Bolivia, officially the Plurinational State of Bolivia, is a landlocked country located in central South America. The country features diverse geography, including vast Amazonian plains, tropical lowlands, mountains, the Gran Chaco Province, w ...
,
Brazil Brazil, officially the Federative Republic of Brazil, is the largest country in South America. It is the world's List of countries and dependencies by area, fifth-largest country by area and the List of countries and dependencies by population ...
,
Paraguay Paraguay, officially the Republic of Paraguay, is a landlocked country in South America. It is bordered by Argentina to the Argentina–Paraguay border, south and southwest, Brazil to the Brazil–Paraguay border, east and northeast, and Boli ...
, and into northern
Argentina Argentina, officially the Argentine Republic, is a country in the southern half of South America. It covers an area of , making it the List of South American countries by area, second-largest country in South America after Brazil, the fourt ...
. Three species (''P. reidyi, P. boliviensis and P. fera'') are found in the
Amazon region The Amazon basin is the part of South America drained by the Amazon River and its tributaries. The Amazon drainage basin covers an area of about , or about 35.5 percent of the South American continent. It is located in the countries of Bolivi ...
, one species (''P. fera'') is restricted to the Amazon, and one (''P. depilata)'' ranges into Central America in
Panama Panama, officially the Republic of Panama, is a country in Latin America at the southern end of Central America, bordering South America. It is bordered by Costa Rica to the west, Colombia to the southeast, the Caribbean Sea to the north, and ...
and
Costa Rica Costa Rica, officially the Republic of Costa Rica, is a country in Central America. It borders Nicaragua to the north, the Caribbean Sea to the northeast, Panama to the southeast, and the Pacific Ocean to the southwest, as well as Maritime bo ...
. The remaining species are restricted to Atlantic Forest of Argentina, Paraguay, and Brazil, including forest fragments in the
Cerrado The Cerrado () is a vast ecoregion of Tropics, tropical savanna in central Brazil, being present in the states of Goiás, Mato Grosso do Sul, Mato Grosso, Tocantins, Maranhão, Piauí, Bahia, Minas Gerais, São Paulo (state), São Paulo, Paraná ...
savanna. In Brazil, ''Phoneutria'' is only absent in the northeastern region north of
Salvador, Bahia Salvador () is a Municipalities of Brazil, Brazilian municipality and capital city of the Federative units of Brazil, state of Bahia. Situated in the Zona da Mata in the Northeast Region, Brazil, Northeast Region of Brazil, Salvador is recognize ...
. ''Phoneutria'' has been introduced to
Chile Chile, officially the Republic of Chile, is a country in western South America. It is the southernmost country in the world and the closest to Antarctica, stretching along a narrow strip of land between the Andes, Andes Mountains and the Paci ...
and
Uruguay Uruguay, officially the Oriental Republic of Uruguay, is a country in South America. It shares borders with Argentina to its west and southwest and Brazil to its north and northeast, while bordering the Río de la Plata to the south and the A ...
.


Banana shipments

These spiders acquired their other common name, "banana spider", because it is claimed that they are occasionally found in shipments of
banana A banana is an elongated, edible fruit – botanically a berry – produced by several kinds of large treelike herbaceous flowering plants in the genus '' Musa''. In some countries, cooking bananas are called plantains, distinguishing the ...
s, though the number of reports is exaggerated due to common misidentifications of unrelated spiders. A survey of spiders found in international shipments to North America revealed that only 7 of 135 spiders were ''Phoneutria'' species, six being '' Phoneutria boliviensis'' from bananas and one ''
Phoneutria nigriventer ''Phoneutria nigriventer'' is a species of medically-significant spider in the family Ctenidae, found in the Southern Cone of South America (Brazil, Uruguay, Paraguay, and Argentina). Along with other members of the genus, they are often referre ...
'' from a shipment of electrical parts. Spiders from genera such as '' Cupiennius'' had been misidentified by experienced arachnologists. Cases continue to be reported but without evidence of expert identification. In 2005, a man was bitten in
Bridgwater Bridgwater is a historic market town and civil parish in Somerset, England. The town had a population of 41,276 at the 2021 census. Bridgwater is at the edge of the Somerset Levels, in level and well-wooded country. The town lies along both sid ...
, England by a spider in a shipment of bananas, and, in 2014, a south London family photographed a spider that they claimed was in a bunch of bananas delivered to their home.


Medical significance

The genus ''Phoneutria'' includes some of the relatively few species of spiders known to present a threat to humans. Danger to humans does not only comprise
toxicity Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage an organism. Toxicity can refer to the effect on a whole organism, such as an animal, bacteria, bacterium, or plant, as well as the effect o ...
, but also factors such as the spider's capacity to deliver a sufficient dose of
venom Venom or zootoxin is a type of toxin produced by an animal that is actively delivered through a wound by means of a bite, sting, or similar action. The toxin is delivered through a specially evolved ''venom apparatus'', such as fangs or a sti ...
, a disposition that makes a bite likely, and proximity to human habitation. These spiders' wandering nature is another reason they are considered so dangerous. In densely populated areas, ''Phoneutria'' species usually search for cover and dark places to hide during daytime, leading them to hide in houses, clothes, cars, boots, boxes, and log piles, where they may bite if accidentally disturbed. Spider mouthparts are adapted to envenomate very small prey; they are not well-adapted to attacking large mammals such as humans. Some believe that various spiders like ''Phoneutria'', that use venom mainly to kill prey, can deliver a "dry" bite in defense to purposely conserve their venom, as opposed to a more primitive spider-like ''
Atrax ''Atrax'' is a genus of venomous Australian funnel web spiders that was first described by O. Pickard-Cambridge in 1877 from the type species '' Atrax robustus''. It contains five species. Originally placed with the curtain web spiders, it wa ...
'' that usually delivers a full load. A study in March 2009 suggests that ''Phoneutria'' inject venom in approximately one-third of their bites, and only a small quantity in one-third of those cases. Another study similarly suggested that only 2.3% of bites (mainly in children) were serious enough to require
antivenom Antivenom, also known as antivenin, venom antiserum, and antivenom immunoglobulin, is a specific treatment for envenomation. It is composed of antibodies and used to treat certain venomous bites and stings. Antivenoms are recommended only if ...
. Research in this area is hindered by the difficulty of identifying particular species. Nevertheless, there are a few well-attested instances of death. In one case, a single spider killed two children in São Sebastião. The spider was positively identified as a ''Phoneutria'' by Wolfgang Bücherl. Fatalities are usually attributed to respiratory arrest, secondary to systemic effects, or directly to envenoming. Systemic effects occur in 9% to 27% of cases; symptoms at the sites are more frequent, occurring from 83% to 96% of cases. The severity of the cases can be related to the sex of the spider, since the male produces less venom and is less lethal than the females, except for ''P. boliviensis'', where the male is more toxic. Symptoms may appear within 10 to 20 minutes after the bite, and death within two to six hours, where severe pain radiates to the rest of the limb, systemic effects include tachycardia, increased blood pressure, vertigo, fever, sweating, visual disturbances, nausea, vomiting, difficulty breathing and paralysis. Death is usually caused by respiratory arrest. These spiders seem to produce a smaller amount of venom during cold months (June to September) a minimum amount of 0.03 mg, an average of 0.44 mg and a maximum of 1.84 mg, during the summer months. The maximum amount among individuals was 3.10 mg (October 26), 4 mg (November 3), 5 mg (November 4) and 8 mg (October 31); 7 mg of dried venom is enough to kill 500 mice
subcutaneously The subcutaneous tissue (), also called the hypodermis, hypoderm (), subcutis, or superficial fascia, is the lowermost layer of the integumentary system in vertebrates. The types of cells found in the layer are fibroblasts, adipose cells, and m ...
and 1,000
intravenously Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutr ...
. ''P. nigriventer'' is the species responsible for most cases of envenomation in Brazil because it is commonly found in highly populated areas of southeastern
Brazil Brazil, officially the Federative Republic of Brazil, is the largest country in South America. It is the world's List of countries and dependencies by area, fifth-largest country by area and the List of countries and dependencies by population ...
, such as the states of
São Paulo São Paulo (; ; Portuguese for 'Paul the Apostle, Saint Paul') is the capital of the São Paulo (state), state of São Paulo, as well as the List of cities in Brazil by population, most populous city in Brazil, the List of largest cities in the ...
,
Minas Gerais Minas Gerais () is one of the 27 federative units of Brazil, being the fourth largest state by area and the second largest in number of inhabitants with a population of 20,539,989 according to the 2022 Brazilian census, 2022 census. Located in ...
,
Rio de Janeiro Rio de Janeiro, or simply Rio, is the capital of the Rio de Janeiro (state), state of Rio de Janeiro. It is the List of cities in Brazil by population, second-most-populous city in Brazil (after São Paulo) and the Largest cities in the America ...
and
Espírito Santo Espírito Santo (; ) is a state in southeastern Brazil. Its capital is Vitória, and its largest city is Serra. With an extensive coastline, the state hosts some of the country's main ports, and its beaches are significant tourist attracti ...
.


Reported cases

A 45-year-old man, with no nervous background, employed in the agricultural section of the Butantan Institute, working barefoot, was bitten at 10:40 AM on the small toe of his left foot by a medium-sized ''Phoneutria''. Immediately he felt intense pain that radiated to his foot and leg. He also reported visual disturbances, and when he tried to enter the building, he fell. Without strength, he was supported by two men to the laboratory, where he was examined. He could not stand, had difficulty seeing, difficulty talking (he could not answer questions), and complained of severe general pain and intense cold. He was sweating profusely, there was hyper nasal secretion and salivation, which made him blow his nose and spit constantly. He was agitated, with generalized tremors and continuous cramps in his left foot and leg, and an irregular pulse with 112 beats per minute. An hour after the accident, the serum was injected into the left buttock. During the next hour, the pulse became faster, thready, almost uncountable, and the temperature decreased, with a worsening of the general condition. At noon the victim received a new injection of serum and by 1:00 pm there was improvement. In another case, a 22-year-old woman, four months pregnant, was bitten on the hand. She experienced severe generalized pain with
paroxysm Paroxysmal attacks or paroxysms are a sudden recurrence or intensification of symptoms, such as a spasm or seizure. These short, frequent symptoms can be observed in various clinical conditions. They are usually associated with multiple scleros ...
, had difficulty keeping up and talking, moaned, had cramps, generalized tremors, excessive sweating, and rapid pulse (140–150 beats per minute); after receiving the antidote the victim stabilized. In another case, a 16-year-old boy was bitten on his left hand. The victim had severe general pain, visual disturbance, generalized tremors, cramps, profuse sweating, and a weak, irregular rapid pulse. A 23-year-old market worker moving a bunch of bananas was bitten on his hand by ''P. nigriventer'' in São Paulo, Brazil. The specimen measured 3.5 cm long and 6 cm with its legs. It was reported that the wound was extremely painful, with the victim noticing that the bite area was sweating and the hair on his skin stood on end. He also reported that the pain radiated to his chest and that his heart began to race. The victim was dizzy and nauseated, felt cold, began to drool and vomit, and exhibited
priapism Priapism is a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended. There are three types: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic (intermittent). Most cases ...
. He was later treated with anesthetics, tetanus prophylaxis, and anti-venom, and recovered 36 hours after the bite. Another case occurred with a 52-year-old man, bitten by an adult female ''P. nigriventer''. Immediately after the bite, he experienced severe local pain, blurred vision, profuse sweating, and vomiting. From one to two hours after the bite he presented agitation and high blood pressure; at four hours after the heart rate was high at 150 beats per minute, mild tachypnea, cold extremities, profuse sweating, generalized tremors, and priapism. He was treated with anesthetics, anti-venom, and fluid replacement. In 2005, an English man was bitten twice by a spider identified as a ''Phoneutria'', which was hidden in a box of bananas. It was reported that his hand became swollen, he felt dizzy, and when he got home he collapsed. He was taken to the hospital and received treatment, but his condition continued to deteriorate. He reported chest tightness, and difficulty breathing, and both his blood pressure and heart rate were high. He was treated with increased saline to release toxins from the body and was discharged the next day. He took almost a week to recover. A 70-year-old man was bitten by a spider with a leg span of 5 to 6 cm. He was cutting sugarcane at the residence of São Pedro de Alcantara, in the countryside, when a spider jumped on his shoulder and came "walking" by the right arm to the back where it bit his hand (bled at the time); he felt intense pain at the time. The spider had several young in the abdomen. The patient evolved with agitation,
anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...
, blood pressure 200x110 mmHg, heart rate of 62 beats per minute, respiratory rate of 36 breathing movements per minute,
respiratory distress Shortness of breath (SOB), known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that c ...
,
hyperemia Hyperaemia (also hyperemia) is the increase of blood flow to different tissues in the body. It can have medical implications but is also a regulatory response, allowing change in blood supply to different tissues through vasodilation (widenin ...
, edema and radiating pain. After 50 minutes, the patient was admitted to the emergency department of the HU with blood pressure 150x90 (after
captopril Captopril, sold under the brand name Capoten among others, is an ACE inhibitor, angiotensin-converting enzyme (ACE) inhibitor used for the treatment of hypertension and some types of congestive heart failure. Captopril was the first oral ACE inh ...
), mild dyspnea (patient pneumectomized by TU), with
paresthesias Paresthesia is a sensation of the skin that may feel like numbness (''hypoesthesia''), tingling, pricking, chilling, or burning. It can be temporary or chronic and has many possible underlying causes. Paresthesia is usually painless and can oc ...
and local condition as previously reported. He received anesthetic infiltration,
dipyrone Metamizole or dipyrone (informally known as the "Mexican aspirin") is a Analgesic, painkiller, Antispasmodic, spasm reliever, and Antipyretic, fever reliever drug. It is most commonly given by mouth or by intravenous infusion. It belongs to the ...
and two vials of serum, the right hand remained red and swollen, with improvement in anxiety symptoms and control blood pressure. Another case occurred in Minas Gerais, Brazil, where a man bitten by a ''Phoneutria'' developed numbness in his legs, redness, headache, and loss of sense of time and space.


Reports of deaths

In a case that occurred in Itanhaém, São Paulo, a 40-year-old man bitten in the foot, presented significant pain and generalized contractures, dying six hours after the accident. A 7-year-old child, bitten in the ear, presented convulsions, opisthotonos, and progressive paralysis, dying 17 hours after the accident. In a case that occurred in
Franca Franca is a municipality in the state of São Paulo, Brazil. The city is located in the northeastern portion of the state, distant 401 km (249 mi) from the state capital São Paulo, and 676 km (420 mi) from Brasilia. It covers a total area of 60 ...
, a 10-year-old child bitten on the middle finger of the right hand, presented severe pain, trismus, tremors in the right arm and face, evolving to permanent contracture, respiratory paralysis, cyanosis, and convulsions, dying in 30–40 minutes after the accident. In
São Sebastião, São Paulo São Sebastião (Portuguese language, Portuguese for Saint Sebastian) is a Brazilian Municipalities of Brazil, municipality, located on the southeast coast of Brazil, in the state of São Paulo (state), São Paulo. The population in 2020 was 90,32 ...
, two brothers, 6 months and 18 months old, the children woke up during the night crying and screaming, dying soon after (time of death is not described). The father removed the sheets and found the spider, which was referred to the Butantan Institute, identified as a large female ''Phoneutria nigriventer''. A 3-year-old girl, bitten on the third finger of her right hand, presented immediate local pain, periods of alternating prostration, cold sweating, chest and abdomen pains, and 3 episodes of vomiting, was admitted to UNICAMP 3 hours after the accident, with the same symptoms. 5 vials of AV (Antivenom) and local anesthetic infiltration were administered, and there was an improvement in symptoms, with a decrease in sweating, but still agitated, 2–3 hours after AV, there was a picture of significant diarrhea (semi-liquid stools) evolving to 2nd-degree dehydration. Parenteral hydration was started, 3h30 min post AV, her heart rate was 160 beats per minute, and her respiratory rate was 72 at 4 hours post AV. Between 4h15min and 4h30min after AV, she had peripheral cyanosis, a heart rate of 150 beats per minute dyspnea, and loss of peripheral venous access. Afterward, there was disseminated pulmonary stertoration, and worsening of agitation, dyspnea, and bradycardia, while being performed orotracheal intubation, manual ventilation, adrenaline, and external cardiac massage, she later died.


Footnotes


External links


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London Evening Standard The ''London Standard'', formerly the ''Evening Standard'' (1904–2024) and originally ''The Standard'' (1827–1904), is a long-established regional newspaper published weekly and distributed free of charge in London, England. It is print ...
, 4 November 2013. {{Taxonbar, from=Q312038 Priapism Ctenidae Ctenidae genera Taxa named by Maximilian Perty