Snakebite
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Předkládaný článek pojednává o základních specifických informacích spojených s intoxikací nemocného po uštknutí jedovatým hadem. Jsou popsány jednotlivé složky hadího jedu, jejich působení na postiženého, klinické projevy, první pomoc a následná léčba včetně ošetřovatelské péče.
This article deals with basic specific information related to the envenoming of a patient resulting from venomous snake bite. The components of snake venom, its effects on the affected person, clinical manifestations, first aid and subsequent treatment are described and nursing care.
- MeSH
- antisérum MeSH
- hadí jedy MeSH
- lidé MeSH
- toxikologie MeSH
- uštknutí hadem * diagnóza ošetřování terapie MeSH
- Check Tag
- lidé MeSH
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.
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
Delays in treatment seeking and antivenom administration remain problematic for snake envenoming. We aimed to describe the treatment seeking pattern and delays in admission to hospital and administration of antivenom in a cohort of authenticated snakebite patients. Adults (> 16 years), who presented with a confirmed snakebite from August 2013 to October 2014 were recruited from Anuradhapura Hospital. Demographic data, information on the circumstances of the bite, first aid, health-seeking behaviour, hospital admission, clinical features, outcomes and antivenom treatment were documented prospectively. There were 742 snakebite patients [median age: 40 years (IQR:27-51; males: 476 (64%)]. One hundred and five (14%) patients intentionally delayed treatment by a median of 45min (IQR:20-120min). Antivenom was administered a median of 230min (IQR:180-360min) post-bite, which didn't differ between directly admitted and transferred patients; 21 (8%) receiving antivenom within 2h and 141 (55%) within 4h of the bite. However, transferred patients received antivenom sooner after admission to Anuradhapura hospital than those directly admitted (60min [IQR:30-120min] versus 120min [IQR:52-265min; p<0.0001]). A significantly greater proportion of transferred patients had features of systemic envenoming on admission compared to those directly admitted (166/212 [78%] versus 5/43 [12%]; p<0.0001), and had positive clotting tests on admission (123/212 [58%] versus 10/43 [23%]; p<0.0001). Sri Lankan snakebite patients present early to hospital, but there remains a delay until antivenom administration. This delay reflects a delay in the appearance of observable or measurable features of envenoming and a lack of reliable early diagnostic tests. Improved early antivenom treatment will require reliable, rapid diagnostics for systemic envenoming.
- MeSH
- antiveniny terapeutické užití MeSH
- čas zasáhnout při rozvinutí nemoci statistika a číselné údaje MeSH
- dospělí MeSH
- hadí jedy * MeSH
- hadi MeSH
- hospitalizace statistika a číselné údaje MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- první pomoc MeSH
- uštknutí hadem diagnóza epidemiologie terapie MeSH
- venkovské obyvatelstvo MeSH
- zvířata MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Srí Lanka MeSH
Autori prezentujú komplexný pohľad na súčasné poznatky po uhryznutí vretenicou (Vipera berus) v spojení so vstreknutím jedu (envenomáciou). Najčastejšie sa jedná o sezónny výskyt v rozmedzí jarných, letných až jesenných mesiacov (marec – október) a najčastejšie je to vretenica severná (obyčajná). Kazuistikami poukazujú na starostlivosť a manažment pacientov po intoxikácii hadím jedom.
The authors present a comprehensive view of the current knowledge of Vipera berus in conjunction with the injection of poison (envenomation). Most often it is a seasonal occurrence in the range of spring, summer to autumn months (March – October) and most often it is the Vipera berus. Case reports point to the care and management of patients after snake venom poisoning.
- MeSH
- antisérum MeSH
- dítě MeSH
- edém etiologie MeSH
- hadí jedy MeSH
- lidé MeSH
- mladiství MeSH
- pasivní imunizace MeSH
- předškolní dítě MeSH
- uštknutí hadem * diagnóza epidemiologie patofyziologie terapie MeSH
- Viperidae zranění MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
- MeSH
- hadí jedy klasifikace otrava škodlivé účinky MeSH
- hojení ran MeSH
- jedy chřestýšů * otrava škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- ošetřovatelská diagnóza MeSH
- uštknutí hadem * ošetřování prevence a kontrola terapie MeSH
- zdravotní sestry v klinické praxi MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
A reptile holder based in the Czech Republic was bitten into his hand and foot by the Northeast saw-scaled viper (Echis pyramidum). The person arrived at the health institution after twenty hours for anuria. Despite the antivenom against the Asian Echis carinatum – the Echis pyramidum's close relative – was readily available and administered repeatedly, the envenoming continued to develop with subsequent coagulopathy, hepatopathy and respiratory failure. The effects of plasmapheresis and symptomatic therapy were positive, but only temporary. Continual renal replacement therapy and plasmapheresis were complicated by thrombotic occlusions of the device tubing set. A turning point arrived following repeated application of imported antivenom containing antigens against venom components of another African saw-scaled viper species, Echis leucogaster (the antivenom containing E. pyramidum antigens was not available). The clinical status, including complications, resolved following 30 days of hospitalization. The case further validates the geographical specifics of immunogenicity of venom components with similar clinical action in snakes of the same genus.
- MeSH
- antiveniny terapeutické užití MeSH
- dospělí MeSH
- lidé MeSH
- neúspěšná terapie MeSH
- uštknutí hadem terapie MeSH
- Viperidae MeSH
- zvířata MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- kazuistiky MeSH
The genus Bothrops is responsible for approximately 90% of snakebites in Brazil. In the present study biomarkers of oxidative stress (OS) were evaluated in the blood of victims of snakebites from Bothrops jararaca and Bothrops jararacussu. Patient monitoring started from the emergency entrance at the hospital up to 30 days, groups divided as follows: time 0 (t0), 24 hours (t24h), 7 days (t7d) and 30 days (t30d). The activities of catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GR), glutathione S-transferase (GST), and myeloperoxidase (MPO), as well as the contents of reduced glutathione (GSH), vitamin E, lipid peroxidation (TBARS), protein carbonyls (PC) were examined in blood. Initial determinations revealed increased CAT, GR and GPx activities and decreased SOD and GST activities together with the depletion of GSH contents, while markers of oxidative damage showed increased TBARS levels and decreased PC concentrations in victims of snakebite compared to controls (blood donors). Regarding the temporal effect, no statistical differences among the groups were detected for the distinct parameters analyzed. The responses obtained in OS biomarkers in victims of snakebite compared to healthy subjects indicate that Bothrops envenomation promoted a pronounced and persistent systemic OS in the blood of those subjects.
- MeSH
- antioxidancia terapeutické užití MeSH
- biomedicínský výzkum metody MeSH
- Bothrops MeSH
- enzymatické testy metody využití MeSH
- glutathion imunologie izolace a purifikace krev MeSH
- karbonylace proteinů imunologie účinky léků MeSH
- lidé MeSH
- oxidační stres * imunologie účinky léků MeSH
- peroxidace lipidů imunologie účinky léků MeSH
- statistika jako téma MeSH
- studie případů a kontrol MeSH
- uštknutí hadem * MeSH
- vitamin E imunologie izolace a purifikace krev MeSH
- zánět * enzymologie imunologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Geografické názvy
- Brazílie MeSH
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.
