Severe Heloderma spp. envenomation: a review of the literature.

Context: Heloderma bites are rare and generally mild, but a few cases can be life threatening. Methods: Description of Heloderma bite was searched in medical literature. Discussion: We present a synthesis of clinical and biomedical effects of envenomation by Heloderma sp. based on 22 well identified cases described in medical literature. Three life-threatening syndromes, concomitant or not, may be involved: (a) angioedema which can lead to respiratory tract obstruction, (b) significant fluid losses due to diarrhea, vomiting and sweating, associated with hypokalemia and sometimes metabolic acidosis, and (c) atrioventricular conduction disorders simulating cardiac ischemia. Conclusion: Heloderma bite are quite rare and generally mild. However, few severe cases may require emergency resuscitation. There is no antivenom, and the treatment is only symptomatic and supportive.