A 35 y.o. was photographing wildlife in Arizona and took this photo

Unfortunately the lizard bit him and now he is in the ED. What do you need to consider?

Why is Gila monster venom so important?

Gila monster bites are very painful  because the lizard uses a powerful jaw to hold and chew its venom into the bite wound through grooves in its teeth.  Pain , swelling nausea and dizziness and shock can result.  The Gila monster is one of three  species of venomous lizards on earth. They are generally nocturnal and eat small birds, mammals and eggs.  They spend most of the time underground. The lizard is native to the southwestern US and Mexico but has become popular as a pet throughout the world.

The bites are rarely fatal to humans  although in   2024 a  34 y.o.man in Colorado was bitten by his pet lizard. His girlfriend was present and was unable to detach the lizard for four minutes. EMS was called and he was found in shock. He later died.

Our patient’s pain resolved in 12 hours and he suffered no serious effects. 

WHY IS THE GILA MONSTER IS SO IMPORTANT

The venom of the Gila monster was found to contain the peptide exendin, which lead to the development of exenatide, then Byetta,  and eventually all the  GLP-1 (glucagon-like peptide-1) drugs for diabetes. 

Glucagon-like peptide slows digestion and prompts the pancreas to release insulin and cause you to feel full after eating.  Jean-Pierre Raufman was a 29 y.o.  gastroenterologist doing research at the NIH and decided to look at Gila monster venom in 1980. It wasn’t until 1986 when Svetlana Mojsov synthesized GLP-1.  By comparing the lizard venom to GLP-1, extendin 4 could be synthesized and Victoza, Ozempic, Wegovy  and now Orforglipron- an oral GLP-1 drug, followed its discovery.

the chemical formula of extendin

GLP-1 agonists also have side effects including the risk of medullary thyroid cancer in those with MEN2.

FUN FACT

If you are bitten on the arm a Gila monster, it  will not release until it feels safe. The current recommendation is to  lower the lizard so its feet are on the ground.  Then pry the jaws open with a stick.  Immobilize the bitten area.

Arizona Poison and Drug Information Center.1-800-222-1222.

Wong O, Cheung W, Fung H, et al. A case of Gila monster (Heloderma suspectum) bite.  HKJEM 2018 Nov. https://doi.org/a0.1177/1024907918755798.

Zhang Y, Wang L, Zhou M, et al. The structure of helokinestatin-5 and its biosynthetic precursor from Gila monster(Helderma suspectum) venom. Peptides 2010 Aug;31(8):1555-61.

Filippatos T, Panagiotopoulou T, Elisaf M. Adverse effects of GLP-1 agonists. Rev Diabet Stud 2015 Feb 10;11(3):202-230.