Abstract
Hump-nosed viper bite is the commonest venomous snakebite in Sri Lanka. Acute kidney injury (AKI) in association with coagulopathy is an important cause of mortality. Immunomodulating effects of fresh frozen plasma (FFP) could block the nephrotoxic effects of venom; and by replenishing depleted clotting factors resulting from venom induced consumption coagulopathy could offer an additional benefit in offsetting renal injury triggered by haematological disturbances. In a non-randomised observational study carried out from 2005 to 2008 in adults at the National hospital of Sri Lanka, the mean time for resolution of coagulopathy among 42 patients treated with FFP at the inception of coagulopathy was 4.7 hours compared to 18 patients treated with isotonic Saline among whom the mean time for normalisation of coagulopathy was 6.2 hours. None of these 60 patients developed acute renal failure. A separate cohort of 32 patients with coagulopathy after hump-nosed viper bite who had not received FFP during this study period developed acute renal failure and required haemodialysis. In the absence of safe and effective antivenom for hump-nosed viper in Sri Lanka, FFP may be a therapeutic option. FFP if given early to selected patients at inception of coagulopathy may prevent AKI and serve to save lives after hump-nosed viper bites.
Highlights
Hump-nosed viper bite is the most common venomous snakebite in Sri Lanka responsible for 22% - 77% of all snakebites [1,2,3]
Immunomodulating effects of fresh frozen plasma (FFP) could block the nephrotoxic effects of venom; and by replenishing depleted clotting factors resulting from venom induced consumption coagulopathy could offer an additional benefit in offsetting renal injury triggered by haematological disturbances
In a non-randomised observational study carried out from 2005 to 2008 in adults at the National hospital of Sri Lanka, the mean time for resolution of coagulopathy among 42 patients treated with FFP at the inception of coagulopathy was 4.7 hours compared to 18 patients treated with isotonic Saline among whom the mean time for normalisation of coagulopathy was 6.2 hours
Summary
Hump-nosed viper bite is the most common venomous snakebite in Sri Lanka responsible for 22% - 77% of all snakebites [1,2,3]. All the reported deaths from hump-nosed viper bite had coagulopathy and acute kidney injury (AKI). In Sri Lanka polyspecific antivenom is used which is imported from India and is raised against the venoms of Naja naja, Bungarus caeruleus, Daboia russelii, and Echis carinatus, but not against hump-nosed viper (Hypnale spp.). The currently available antivenom is ineffective for hump nosed viper bite and is associated with a high incidence of adverse reactions including anaphylaxis and death [9,10,11,12]. In the absence of safe and effective antivenom for hump nosed viper bite a search for optional pharmacotherapeutic interventions addressing the critical clinical effects of systemic envenomation responsible for mortality was performed
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