Snake bite during pregnancy is rare condition, and when it occurs there are two patients, mother and fetus. Timing is particularly important for pregnant women bitten by a snake. The earlier in the pregnancy the bite occurs, the more hazard to the fetus there is, and there are case reports of snake-bite-induced abortion and malformation of the fetus. The usefulness of antivenin during pregnancy is debatable. We report a case of snake bite during thirdtrimester pregnancy in a patient with general symptoms of envenomation and progressing edema in the bitten leg who was successfully treated with an emergency Caesarian section following the administration of antivenin.
Antivenins ; Bites and Stings ; Edema ; Emergencies ; Female ; Fetus ; Humans ; Leg ; Mothers ; Pregnancy ; Pregnant Women ; Snake Bites ; Snakes

PURPOSE: Antivenin is a standard therapy in snakebite victims. While the required antivenin dose can be easily estimated, based on the initial symptoms, this strategy may be unsuccessful if the initial symptoms progressively worsen. The purpose of this study was to identify the progression rate of the initial symptoms following snakebite and its associated factors. METHODS: The medical records of 44 patients treated for snakebite from give the actual dates of the study period were retrospectively examined. Thirty-two of these patients were enrolled. Demographic data, local wound grade and local effect score at initial presentation (G-0 and LES-0, respectively) and 12 hours after admission (G-12 and LES-12, respectively) were reviewed, along with laboratory data. RESULTS: The 32 patients had an average age of 54.0+/-14.5 years and were predominantly male (n=26) and presented mainly during summer. Compared to G-0 and LES-0, re-evaluated G-12 and LES-12 were significantly increased despite initial administration of proper antivenin dosage (p=0.001 and p=0.000, respectively). Total amounts of antivenin correlated with LES-12 (correlation co-efficiency 0.558, p<0.05). However, factors associated with symptom progression were not revealed. CONCLUSION: Initial snakebite symptoms might progressively worsen within hours despite acceptable initial antivenin therapy. Therefore, re-evaluation within several hours must be considered if when the initial snakebite symptoms are minimal or mild.
Antivenins ; Chronology as Topic ; Disease Progression ; Humans ; Male ; Medical Records ; Retrospective Studies ; Snake Bites

PURPOSE: Serious complications from snake bite envenomization are relatively rare in Korea. According to standrad treatment guidelines for local and systemic injuries, antivenin is not recommended for snake bite cases when victims show minimal clinical symptoms. However, there are no published stidies about the effectiveness of antivenin treatment in such cases in Korea. In order to provide actual documentation to support a standard for treatment, we evaluated the effectiveness of antivenin use by comparing clinical outcomes in snake bite patients exhibiting minimal clinical symptoms (traditional snake bite severity grades 0 and I). METHODS: We retrospectively reviewed 140 snake bite cases of patients with minimal clinical symptoms who visited the emergency departments of Chungnam National University Hospital, Cheonan Medical Center, and Chungnam Seosan Medical Center in Korea from January 2000 to December 2006. We categorized the patients into antivenin (group 1) and non-antivenin (group 2) treatment groups. We compared clinical outcomes and characteristics of the two groups. RESULTS: Neither demographic factors nor clinical outcomes showed statistical significance between the groups. CONCLUSION: In case of snake bite victims in Korea, antivenin treatment should not generally recommended as treatment for victims exhibiting minimlal clinical symptoms.
Antivenins ; Chungcheongnam-do ; Demography ; Emergency Service, Hospital ; Humans ; Korea ; Retrospective Studies ; Snake Bites* ; Snakes* ; Treatment Outcome

PURPOSE: The aim of this study was to help set the domestic guidelines for administration of antivenom to envenomated patients with snake. METHODS: This retrospective observation case series comprised 128 patients with a snake envenomation. The patients were divided into two groups according to the need for additional antivenom after the initial treatment strategy based on the traditional snakebite severity grading scale; one group recovered successfully with the initial treatment decision and did not require an additional antivenom (N=85) and the other group required an additional administration of antivenom later (N=43). RESULTS: The group requiring additional administration of antivenom showed a higher local effect score and traditional snakebite severity grading at presentation, a shorter prothrombin and activated partial prothrombin time, a higher frequency of rhabdomyolysis and disseminated intravascular coagulopathy, and longer hospitalization than the group that did not require an antivenom later. The most common cause of additional administration was the progression of local symptoms. The independent factor associated with the need for additional antivenom administration was a local effect scoring of pain score (odds ratio, 2.477; 95% confidence interval, 1.309 to 4.689). The optimal cut off value of local effect scoring of pain was 1.5 with 62.8% sensitivity and 71.8% specificity. CONCLUSION: The local effect scoring of pain should be considered when treating patients who are envenomated with a snake using the traditional snakebite severity scale. If the local effect scoring of pain is more than 2, an increase of antivenom should be considered and the patients should be assessed frequently.
Antivenins ; Hospitalization ; Humans ; Prothrombin ; Prothrombin Time ; Retrospective Studies ; Rhabdomyolysis ; Sensitivity and Specificity ; Snake Bites* ; Snakes* ; Venoms

Snake antivenomimmunoglobulins are considered to be the most efficient drugs in snake envenomings. Most snake antivenomimmunoglobulins all over the world are still prepared by fragmentation of polyclonal antibodies isolated from hyper-immunized horse serum till now. In this review, we retrospect the history of snake antivenomimmunoglobulins, analysis the present situation and pay the close attention on the key technological links in the process of research and manufacturing, such as properties of IgG and its fragments, selection and preparation of immunogen, optimization of immunization schedule and protein isolation and purification, which can be available for the reference in the research and development of snake antivenom.
Animals ; Antivenins ; pharmacology ; Humans ; Immunoglobulin G ; pharmacology ; Snake Bites ; drug therapy ; Snakes

OBJECTIVE: This study aims to help set domestic guidelines for administration of antivenom to envenomated patients after snakebites. METHODS: This retrospective observational case series comprised 128 patients with snake envenomation. The patients were divided into two groups according to the need for additional antivenom after the initial treatment based on the traditional snakebite severity grading scale. One group successfully recovered after the initial treatment and did not need any additional antivenom (n=85) and the other needed an additional administration of antivenom (n=43). RESULTS: The group requiring additional administration of antivenom showed a higher local effect score and a traditional snakebite severity grade at presentation, a shorter prothrombin and activated partial prothrombin time, a higher frequency of rhabdomyolysis and disseminated intravascular coagulopathy, and longer hospitalization than the group that did not need additional antivenom. The most common cause for additional administration was the progression of local symptoms. The independent factor that was associated with the need for additional antivenom was the local effect pain score (odds ratio, 2.477; 95% confidence interval, 1.309 to 4.689). The optimal cut-off value of the local effect pain score was 1.5 with 62.8% sensitivity and 71.8% specificity. CONCLUSION: When treating patients who are envenomated by a snake, and when using the traditional snakebite severity scale, the local effect pain score should be taken into account. If the score is more than 2, additional antivenom should be considered and the patient should be frequently assessed.
Antivenins ; Hospitalization ; Humans ; Prothrombin ; Prothrombin Time ; Retrospective Studies ; Rhabdomyolysis ; Sensitivity and Specificity ; Snake Bites* ; Snakes ; Venoms

PURPOSE: The aim of this study was to evaluate the feasibility and safety of our antivenin treatment protocol for patients with Korean Viperidae envenomation. METHODS: We developed an antivenin treatment protocol for Korean Viperidae envenomation, based on previous data, and applied this treatment to the enrolled patients. In brief, antivenin was not used for patients with grade 0. Patients with grade I and II received one vial of antivenin. Those with grade III and IV received two and three vials of antivenin, respectively. Adult patients who visited the emergency department (ED) after receiving a snakebite between July 2008 to August 2010 were included. Follow ups were performed at 24 hours, 7 days, and 28 days after the snakebite. RESULTS: A total of 62 patients were enrolled. At the initial evaluation, 6 patients (9.7%) were grade 0, 47 patients (75.8%) were grade I, and 9 patients (14.5%) were grade II. Upon the follow-up evaluation, 14 patients (29.8%) progressed from grade I to grade II and 2 patients (22.2%) progressed from grade II to III. Coagulopathy developed in 5 patients (8.0%) and rhabdomyolysis in 5 patients (8.0%). Urticaria developed in 2 patients (3.2%) and cellulitis in 3 patients (4.8%) as delayed complications. As an antivenin-related complication, serum sickness developed in only 1 patient (1.6%). There were no severe complications and all clinical and laboratory abnormalities disappeared within 28 days. CONCLUSION: Our antivenin treatment protocol was feasible and safe. To confirm our data, multicenter validation studies are needed.
Adult ; Antivenins ; Cellulitis ; Clinical Protocols ; Emergencies ; Follow-Up Studies ; Humans ; Rhabdomyolysis ; Serum Sickness ; Snake Bites ; Snake Venoms ; Urticaria ; Viperidae

Venomous snakes are estimated to inflict 400,000 bites annually, resulting in approximately 40,000 deaths. There are nearly 3,500 known species of snakes worldwide, and three species exist in Korea. Venom contains toxins that effect the cardiovascular system, the kidneys, the respiratory system and the muscles. There are many modalities in treating snake bites, but most of all, neutralization of the venom is the most important. however, many doctors in Korea hesitate in using antivenom. The reason is that there are no specific antivenoms against Korean venous snakes. In this case, a 2-year-old female child with a snake bite vistied our hospital Korea via a local clinic. Severe systemic symptoms and local symptoms, including compartment syndrome, were observed. When we tried antivenom, the result was satisfactory.
Agkistrodon* ; Antivenins ; Cardiovascular System ; Child ; Child, Preschool ; Compartment Syndromes ; Female ; Humans ; Kidney ; Korea ; Muscles ; Respiratory System ; Snake Bites* ; Snakes* ; Venoms

Snake bites are one among the under reported clinical emergencies from tropical countries. There are variations in clinical presentation of snake bites and its toxic features differ with the species and type of bite. There are lots of controversies in the treatment guidelines which often makes it difficult to manage. We report the case of a severe hemotoxic snake bite who presented to the outpatient service of our hospital with a trivial foot injury. Even though snakebites are familiar clinical situations for an emergency physician from tropics, we report this case as most are under reported. We also intend to emphasize the excellent outcome of appropriately diagnosed and treated cases of snake bite.
Adult ; Animals ; Anticoagulants ; toxicity ; Antivenins ; therapeutic use ; Blood Coagulation ; Humans ; Male ; Snake Bites ; blood ; drug therapy ; pathology ; Snake Venoms ; toxicity ; Viperidae

The authors wish to report a case of bilateral acute anterior uveitis and optic disc edema following a hemotoxic snake bite, in order to highlight the concomitant occurrence of these conditions and the potential adverse effects of anti-snake venom (ASV). A 35-year-old male was bitten by a viper at seventeen thirty hours, and was started on ASV. Two days following treatment he experienced sudden onset redness and painful diminution of vision in both eyes (OU). On examination, the patient's visual acuity (VA) in OU was 20/200. Examination revealed fresh keratic precipitates, cells, and flare in the anterior chamber (AC), posterior synechiae, sluggish and ill-sustained pupillary reaction, and hyperemic, edematous disc with blurred margins in OU. He was started on topical steroids, cycloplegics and intravenous methylprednisolone. Following treatment, the patient showed improvement and was continued on topical medications and oral prednisolone tapered over 3 weeks, after which VA OU improved, the AC showed no cells and flare and disc edema resolved. Uveitis and optic disc edema in snake bite can either be due to the direct toxic effects of the venom or the effect of ASV. Steroids have a beneficial role in the management of these symptoms.
Acute Disease ; Adult ; Antivenins/*adverse effects ; Glucocorticoids/administration & dosage ; Humans ; Hyperemia/drug therapy/etiology/pathology ; Male ; Methylprednisolone/administration & dosage ; Papilledema/drug therapy/*etiology/pathology ; Snake Bites/*complications/*therapy ; Uveitis, Anterior/drug therapy/*etiology/pathology