Envenomations that are caused by Viperidae snakebites are mostly accompanied by venom-induced consumption coagulopathy (VICC) with defibrination. The clinical course of VICC is well described; however, reports about its detailed effects in the hemocoagulation systems of patients are sparse. In this pilot study, we prospectively analyzed the changes in plasma fibrinogen that were caused by the envenomation of six patients by five non-European Viperidae snakes. Western blot analysis was employed and fibrinogen fragments were visualized with the use of specific anti-human fibrinogen antibodies. All of the studied subjects experienced hypo- or afibrinogenemia. The western blot analysis demonstrated fibrinogenolysis of the fibrinogen chains in all of the cases. Fibrinogenolysis was considered to be a predominant cause of defibrination in Crotalus, Echis, and Macrovipera envenomation; while, in the cases of VICC that were caused by Atheris and Calloselasma envenomation, the splitting of the fibrinogen chains was present less significantly.
Coagulopathy with defibrination is one of symptoms accompanying snakebite envenoming, where life-threatening complications such as massive bleeding and organ hematomas formation can occur. Here, we report a case of hemocoagulation failure due to bite by African Great Lakes bush viper Atheris nitschei with impossibility of specific treatment for absence of antivenom and its life-threatening complication: very rare and unexpected atraumatic splenic rupture with massive hemoperitoneum and necessity of urgent splenectomy.
OBJECTIVE: Viperidae snakes are responsible for 95 % of the bites caused by exotic-bred snakes in our country. Their envenoming may be associated with a severe acute coagulation disorder – venom-induced consumption coagulopathy (VICC). Thus, its early prediction is vital for an adequate therapy including antivenom delivery.MATERIAL AND METHODS: Laboratory coagulation tests of 14 patients suffering from VICC were processed and statistically analyzed to evaluate the importance of individual parameters in the time after the bite.RESULTS: The pathological values of D-dimer (D-dim) and fi brinogen (FBG) were found to be the fi rst indica-tors of VICC development, with a median time of 4.55 hours since the bite, while median values for prothrombin time and international normalized ratio (PT/INR), activated partial thromboplastin time (APTT), and thrombin time (TT) were 5.9 h, 8.15 h, and 5.5 h, respectively. In the first samples, the values of D-dim were found to be pathologically increased in all 14 patients, while pathological levels of FBG were seen only in 11 cases. PT/INR and APTT were prolonged in 8 and 6 cases, respectively. CONCLUSION: An increase in D-dim values was found to be the first parameter signaling developing VICC in all analyzed cases (Tab. 2, Ref. 12). Text in PDF www.elis.sk.
Učební texty Univerzity Karlovy
Second edition 109 stran : ilustrace ; 30 cm
- Konspekt
- Anatomie člověka a srovnávací anatomie
- Učební osnovy. Vyučovací předměty. Učebnice
- NLK Obory
- anatomie
- NLK Publikační typ
- učebnice vysokých škol
- MeSH
- kontinuální vzdělávání lékařů * MeSH
- lidé MeSH
- odměny a ceny MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- interaktivní tutorial MeSH
- O autorovi
- Valenta, Jiří, 1951- Autorita
A snake breeder, 47-years-old man, was bitten by the saw-scaled viper (Echis carinatus sochureki). After admission to Toxinology Centre, within 1.5 h, laboratory evaluation showed clotting times prolonged to non-measurable values, afibrinogenaemia, significantly elevated D-dimers, haemolysis and myoglobin elevation. Currently unavailable antivenom was urgently imported and administered within 10 hours. In 24 hours, oligoanuric acute kidney injury (AKI) and mild acute respiratory distress syndrome (ARDS) developed. Despite administration of 10 vials of urgently imported Polyvalent Snake Antivenom Saudi Arabia, the venom-induced consumption coagulopathy (VICC) and AKI persisted. Another ten vials of antivenom were imported from abroad. VICC slowly subsided during the antivenom treatment and disappeared after administration of total 20 vials during 5 day period. No signs of haemorrhage were present during treatment. After resolving VICC, patient was transferred to Department of Nephrology for persisting AKI and requirement for haemodialysis. AKI completely resolved after 20 days. Despite rather timed administration of appropriate antivenom, VICC and AKI developed and the quantity of 20 vials was needed to cease acute symptoms of systemic envenoming. The course illustrates low immunogenicity of the venom haemocoagulation components and thus higher requirements of the antivenom in similar cases.
- MeSH
- akutní poškození ledvin * diagnóza etiologie terapie MeSH
- antiveniny aplikace a dávkování MeSH
- dialýza ledvin metody MeSH
- hemokoagulace účinky léků MeSH
- imunologické faktory aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- uštknutí hadem * krev komplikace patofyziologie terapie MeSH
- Viperidae * MeSH
- vyšetření krevní srážlivosti metody MeSH
- výsledek terapie MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- zmijí jedy toxicita MeSH
- zvířata MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Snakebites by exotic venomous snakes can cause serious or even life-threatening envenoming. In Europe and North America most victims are breeders, with a few snakebites from wild native American rattlesnakes. The envenomed victims may present in organ and/or system failure with muscle paralysis, respiratory failure, circulatory instability, acute kidney injury, severe coagulation disorder, and local disability - compartment syndrome and necrosis. Best managed by close collaboration between clinical toxicology and intensive care, most severe envenomings are managed primarily by intensive care physicians. Due to the low incidence of severe envenoming, the clinical course and correct management of these cases are not intrinsically familiar to most physicians. This review article summarizes the clinical syndromes caused by severe envenoming and the therapeutic options available in the intensive care setting.
- MeSH
- antiveniny terapeutické užití MeSH
- fyzikální vyšetření MeSH
- hadí jedy otrava MeSH
- hadi MeSH
- lidé MeSH
- terapie náhlých příhod metody MeSH
- uštknutí hadem diagnóza farmakoterapie MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- MeSH
- dospělí MeSH
- lidé MeSH
- neurotoxické syndromy diagnóza etiologie metabolismus MeSH
- nikotinové receptory metabolismus MeSH
- nikotinoví agonisté * MeSH
- uštknutí hadem komplikace diagnóza metabolismus MeSH
- Viperidae * MeSH
- výsledek terapie MeSH
- zmijí jedy * MeSH
- zvířata MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- dopisy MeSH
- kazuistiky MeSH
