Abstract
This clinical case of acute poisoning due to bite of snake Dendroaspis viridis seems interesting to share because of its rare incidence inRussiaand management peculiarities: the critical care was conducted without specific antidote therapy due to absence of the antidote.The prevailing clinical presentation included signs of toxic myopathy combined with paresis of skeletal and breathing muscles that led to development of acute respiratory failure and metabolic disorders. The processes described were induced by the action of snake poison dendrotoxins featuring the activities of potassium channel blockers and acetyl cholinesterase inhibitors.The proper critical care included conduct of syndrome therapy aimed at maintaining life support systems adequately to condition (replacement of the breathing and circulation functions), antibiotic therapy and desensitizing treatment and metabolic care by administration of drugs characterized by antihypoxant/antioxidant mechanism of action.The comprehensive therapy applied has resulted in a favorable outcome of acute poisoning by snake green mamba without development of possible complications even when the specific antidote drug has not been included into the treatment protocol.
Highlights
From time to time, papers appear in medical literature, which describe acute poisoning because of bites of exotic snakes [1,2,3,4].In Russia and other countries of the world, such snakes include, in particular, green or western mamba (Dendroaspis viridis); class — Reptilia; order — Squamata; family — Elapidae; genus — Dendroaspis
The most dangerous symptom group is related to the neurotoxic effect of poison, characterized by progressing acute respiratory failure and development of cardiotoxic and nephrotoxic symptoms [6–8]
One of the main components of green mamba’s poison is dendrotoxins, which belong to the class of presynaptic neurotoxins blocking specific subtypes of potential-dependent potassium channels in neurons, increasing release of acetylcholine in neuromuscular synapses [11]
Summary
Успешный исход острого отравления ядом зеленой мамбы (Dendroaspis viridis) клиническое наблюдение. Данное клиническое наблюдение острого отравления после укуса змеи Dendroaspis viridis интересно в связи с его редкой встречаемостью в России и особенностями терапевтической тактики: интенсивная терапия проводилась без использования специфической антидотной терапии вследствие отсутствия антидота. Ключевые слова: острые отравления; яды, укусы змей; зеленая мамба; метаболические расстройства; цитофлавин; реамберин This clinical case of acute poisoning due to bite of snake Dendroaspis viridis seems interesting to share because of its rare incidence in Russia and management peculiarities: the critical care was conducted without specific antidote therapy due to absence of the antidote. Основой же лечебных мероприятий при острых отравлениях вследствие укуса зеленой мамбы по указанным данным является проведение антидотной терапии противозмеиной сывороткой, при тяжелых формах острых отравлений доза может составлять до 12 флаконов [10]. Наряду с этим терапия при отравлении вследствие укусов змей заключается в про-
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