Signs Of Systemic Envenomation Research Articles

Evaluation of antivenom therapy for Vipera palaestinae bites in children: experience of two large, tertiary care pediatric hospitals

Background: Antivenom has been successfully used to treat systemic and progressive, local manifestations of envenomation inflicted by Vipera (V.) palaestinae, the most common venomous snake in Israel. The objective of this study was to evaluate the fixed dose V. palaestinae monovalent (equine) immunoglobulin G antivenom used in two pediatric emergency departments. In particular, we wanted to assess the need for repeated antivenom administration and the rate of adverse antivenom effects in children.Methods: A retrospective chart review was performed for all children admitted with definite or probable signs of V. palaestinae envenomation to Chaim Sheba Medical Center and Kaplan Medical Center between 1 March 2008 and 1 March 2014. Extracted data included: age, location of bite, time to hospital arrival, time to antivenom administration if indicated, outcomes, and complications of the envenomation and adverse effects to the antivenom.Results: 57 patients met inclusion criteria; they ranged from 1 to 17 years in age and median age was 9.5 years. Clinical manifestations were evident in 55 (96.4%) of victims: 18 presented with minimal local signs and 37 showed marked progressive, local features (rapidly progressing edema) and signs of systemic envenomation: tachycardia (20), vomiting (17), abdominal pain (11) and hypotension (6). Two patients developed compartment syndrome and underwent surgical decompression (both received only a loading dose of antivenom with no subsequent maintenance dose). One patient developed thrombocytopenia and three patients presented with mild coagulopathy. Antivenom was administered to 25 (42%) children. Indications for antivenom administration included moderate to severe local signs (19 patients) and systemic signs (6 patients). None of these patients developed adverse reactions, serum sickness, or other side effects to the antivenom. One patient received a single additional 30mL dose of antivenom, due to hypotension and syncope, with good response.Conclusions: In children, 50 ml dosing of V. palaestinae antivenom is efficacious and safe for the treatment of systemic and progressive local manifestations of envenomation by V. palaestinae.

A case of bilateral occipital lobe infarcts following Indian tree viper bite.

A case of bilateral occipital lobe infarcts following Indian tree viper bite.

Review of Eastern coral snake (Micrurus fulvius fulvius) exposures managed by the Florida Poison Information Center Network: 1998–2010

Context. Envenomation by the Eastern coral snake is rare but may be associated with significant morbidity. While effective, acquisition of North American Coral Snake Antivenin (NACSAV) is difficult because production was discontinued for many years. Objective. The purpose of this study is to characterize coral snake exposures in Florida and determine the effects of varying treatment paradigms on patient outcomes. Methods. This study is an observational case series of cases received at Florida poison centers. Included cases were Eastern coral snake exposures occurring between January 1, 1998 and October 31, 2010. Excluded cases included those found to be unrelated or those not followed for at least 24 h post envenomation. Case comments were reviewed to obtain data. Comparisons were made between asymptomatic patients receiving empiric antivenom therapy (empiric group) and those asymptomatic patients who received antivenom upon developing signs of systemic envenomation (withhold group). Results. Of the 553 cases identified, 387 were included in the final analysis. According to case comments, 56.3% of patients had no reported systemic symptoms. Most commonly, patients were reported to have pain (40.6%), paresthesias (28.4%), nausea (12.7%), and emesis (11.4%). NACSAV was administered to 252 patients (65%). Of those patients receiving NACSAV, 18.25% were reported to have had an adverse reaction. Patients in the withhold group (n = 106) had significantly fewer minor, moderate, and major outcomes than patients in the empiric group (n = 134, p < 0.01). Discussion. While patients in the withhold group had favorable outcomes compared with those in the empiric group, this strategy cannot be applied to all patients presenting asymptomatic to healthcare facilities due to study limitations.Conclusion. Further studies are needed to determine what treatment strategy is most appropriate for asymptomatic patients presenting to healthcare facilities.

Envenomation by the Hump-Nosed Viper (Hypnale hypnale)

We carried out a prospective clinical study from June to December 1993 at the Base Hospital in Avissawella, Sri Lanka to determine the clinical features of envenomation by the hump-nosed viper (Hypnale hypnale). Sixty-two consecutive adult patients (63% males and 37% females, with a median age of 30 years [age range 13-68 years]) admitted to the medical unit following hump-nosed viper bites were surveyed. Most (85.48%) of the patients were bitten on the feet, while 14.52% of the patients were bitten either on the hands or forearms. Most (61.29%) of the patients were bitten during the evening hours (6:00-10:00 PM). The mean time for admission to the hospital following the bite was 1.5 hr (range 0.25-13 hr). All patients had signs of local envenomation manifested by pain, swelling, and induration at the site of the bite, which was occasionally associated with local hemorrhagic blister formation (11.29%) and regional lymphadenopathy (24.19%). None of the patients had signs of systemic envenomation.

Emergency treatment of adder bites: case reports and literature review.

Five cases of adder bites are presented. The clinical effects and current recommendations for the treatment of adder bites are described based on a review of previously published literature. All adder bites, or snake bites of unknown species, should be observed for a minimum of 2 h. Those with no local swelling may be allowed home with appropriate antitetanus prophylaxis. Patients with local reaction or signs of systemic envenoming should be admitted for 48 h with ECG monitoring, and antivenom obtained. Indications and precautions for administration of antivenom are reviewed. Early antivenom treatment may reduce mortality and morbidity from adder bites.

Acute Anuric Renal Failure After Pigmy Rattlesnake Bite

Acute renal failure has been known to follow viper bites in up to 30% of patients, but we believe we have reported the first case in which anuric renal failure developed after the bite of a pigmy rattlesnake. Our patient's renal failure is thought to have been due to a combination of rhabdomyolysis and intrarenal thrombosis caused by DIC. Prompt surgical debridement should be offered to the victim of a bite by any poisonous snake, and antivenin should be administered to any patient with signs of systemic envenomation, with close monitoring for signs of allergic reactions.

Acute pancreatitis in children following envenomation by the yellow scorpion Leiurus quinquestriatus

Plasma immunoreactive cationic trypsin (ICT), which is a specific and highly sensitive indicator of pancreatic injury, was measured in 14 children with signs of systemic envenomation following a sting by the scorpion Leiurus quinquestriatus. High ICT levels were found in 13 children (93%), indicating that acute pancreatitis is a common complication of envenomation by this scorpion. The pancreatitis may account for the abdominal pain and vomiting commonly seen in scorpion envenomation and may also contribute to the agitation and discomfort noted in young children.