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

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: Ocular manifestations in snake-bite injuries are quite rare. However, the unusual presentations, diagnosis and their management can pose challenges when they present to the ophthalmologist. Early detection of these treatable conditions can prevent visual loss in these patients who are systemically unstable and are unaware of their ocular condition. To address this, a study was conducted with the aim of identifying the various ocular manifestations of snake bite in a tertiary care center. METHODS: This is a one-year institute-based prospective study report of 12 snake bite victims admitted to a tertiary hospital with ocular manifestations between June 2013 to June 2014, which provides data about the demographic characteristics, clinical profiles, ocular manifestations, and their outcomes. RESULTS: Twelve cases of snake bite with ocular manifestations were included of which six were viper bites, three were cobra bites and three were unknown bites. Six patients presented with bilateral acute angle closure glaucoma (50%), two patients had anterior uveitis (16.6%) of which one patient had concomitant optic neuritis. One patient had exudative retinal detachment (8.3%), one patient had thrombocytopenia with subconjunctival hemorrhage (8.3%) and two patients had external ophthalmoplegia (16.6%). CONCLUSIONS: Bilateral angle closure glaucoma was the most common ocular manifestation followed by anterior uveitis and external ophthalmoplegia. Snake bite can result in significant ocular morbidity in a majority of patients but spontaneous recovery with anti-snake venom, steroids and conservative management results in good visual prognosis.
Acute Disease ; Adolescent ; Adult ; Animals ; Antivenins/therapeutic use ; *Elapidae ; Female ; Follow-Up Studies ; Glaucoma, Angle-Closure/diagnosis/*etiology/therapy ; Humans ; Male ; Middle Aged ; Ophthalmoplegia/diagnosis/*etiology/therapy ; Prospective Studies ; Snake Bites/*complications/diagnosis/therapy ; Snake Venoms/*poisoning ; Tertiary Healthcare ; Time Factors ; Uveitis, Anterior/diagnosis/*etiology/therapy ; *Viperidae ; Young Adult

PURPOSE: Snakebite is an emergency which causes local symptoms such as pain and edema around the bite. Systemic symptoms may also develop, such as dizziness or renal failure, and may even cause death. The purpose of this research was to assess the validity and safety of snakebite protocol for surgery when treating snakebite patients. MATERIALS AND METHODS: Retrospective research was performed on patients who were admitted after being treated at the emergency center from January 2008 to December 2012. When necessary, debridement was also performed, and 46 of 111 patients (41.4%) underwent debridement. Those who had received debridement without antivenom administration due to a positive skin reaction test were classified as group A, and group B received antivenom and delayed debridement. We reviewed the emergency and admission charts of the patients in each group and recorded and compared their age, sex, bite site, severity of local and general symptoms, time to receive antivenin, and complications. RESULTS: Of the ten patients (21.7%) in group A, two (66.6%) developed cellulites, and one of them experienced skin necrosis, resulting in a skin graft. In group B, there were 36 patients (78.2%), 19 (52.7%) of whom developed cellulitis. Skin necrosis occurred in two patients, and one of these patients received a skin graft. Compartment syndrome was found in one patient, and fasciotomy and a skin graft were performed. CONCLUSION: The treatment protocol implemented to treat snakebite patients admitted to the emergency center during this research was safely and properly followed during surgical treatment.
Adult ; Aged ; Antivenins/administration & dosage ; Combined Modality Therapy ; Compartment Syndromes ; Debridement/*methods ; Disease Management ; Edema/etiology ; Female ; Humans ; Male ; Middle Aged ; Necrosis ; *Practice Guidelines as Topic ; Republic of Korea ; Retrospective Studies ; Severity of Illness Index ; Skin/pathology ; Skin Transplantation/*methods ; Snake Bites/complications/*diagnosis/pathology/*surgery ; Snake Venoms/adverse effects ; Soft Tissue Injuries/etiology/*pathology/surgery ; Treatment Outcome ; Wound Healing/physiology

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

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

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

OBJECTIVETo observe the clinical efficacy of combination of traditional Chinese medicine and western medicine in the treatment of patient bitten by agkistrodon halys pallas, and the changes in peripheral blood inflammatory factors (hs-PCR, IL-6, TNF-alpha).

METHODNinty-eight patients were divided into three groups according to their hospitalization dates: the western medicine group, in which 32 patients were treated with antivenom serum (6 000 U) for five days, once every day; the traditional Chinese medicine group, in which 32 patients were treated with anti pit viper No. 2 concentrated decoction (300 mL), twice to three times every day, for five days; and the combined traditional Chinese medicine and western medicine group, in which 35 patients were treated with the combination of Chinese and Western medicine treatment described above. Then blood samples of all of patients were obtained, and serum factors (hs-PCR, IL-6, TNF-alpha) in peripheral blood were measured by Elisa assay. Another 30 health volunteers were chosen as the normal control group.

RESULTThe serum inflammatory factors were significantly higher in all patients of the three groups than that in healthy control before treatment (P < 0.01), and decreased significantly after treatment. In particular, the more remarkable reduction was found in the combined traditional Chinese medicine and western medicine group compared with the western medicine group and the traditional medicine group (P < 0.01). Symptom elimination in the three groups was superior to the western medicine group and the traditional medicine group at the first day and the third day of treatment (P < 0.05, P < 0.01). Total clinical effective rate was 100% in the combined traditional Chinese medicine and western medicine group, 84. 37% in the traditional medicine group and 65.62% in the western medicine group, the clinical effective rate of the combined traditional Chinese medicine and western medicine group was notably superior to that of the western medicine group and the traditional medicine group (P < 0.01).

CONCLUSIONThe serum inflammatory factors increased significantly in patients bitten by agkistrodon halys pallas. Treatment with the combined traditional Chinese medicine and western medicine can significantly decrease the serum inflammatory factors, and increase clinical effect, with more obvious clinical efficacy compared with the western medicine group and the traditional medicine group.

Adolescent ; Adult ; Aged ; Antivenins ; administration & dosage ; Child ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Interleukin-6 ; blood ; immunology ; Male ; Middle Aged ; Snake Bites ; blood ; drug therapy ; immunology ; Treatment Outcome ; Tumor Necrosis Factor-alpha ; blood ; immunology ; Young Adult

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

INTRODUCTIONThis is a retrospective study on the epidemiology of snakebites that were presented to an emergency department (ED) between 2004 and 2008.

MATERIALS AND METHODSSnakebite cases were identified from International Classification of Diseases (ICD) code E905 and E906, as well as cases referred for eye injury from snake spit and records of antivenom use.

RESULTSFifty-two cases were identified: 13 patients witnessed the snake biting or spitting at them, 22 patients had fang marks and/or clinical features of envenomations and a snake was seen and the remaining 17 patients did not see any snake but had fang marks suggestive of snakebite. Most of the patients were young (mean age 33) and male (83%). The three most commonly identified snakes were cobras (7), pythons (4) and vipers (3). One third of cases occurred during work. Half of the bites were on the upper limbs and about half were on the lower limbs. One patient was spat in the eye by a cobra. Most of the patients (83%) arrived at the ED within 4 hours of the bite. Pain and swelling were the most common presentations. There were no significant systemic effects reported. Two patients had infection and 5 patients had elevated creatine kinase (>600U/L). Two thirds of the patients were admitted. One patient received antivenom therapy and 5 patients had some form of surgical intervention, of which 2 had residual disability. One patient had heparin instilled in the eye for eye injury from cobra spit.

CONCLUSIONSSnakebite infrequently presents to the ED. Most of the patients developed local effects that do well with supportive treatment.

Adolescent ; Adult ; Aged ; Animals ; Antivenins ; therapeutic use ; Elapidae ; Female ; Hospitals, General ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Saliva ; Singapore ; epidemiology ; Snake Bites ; drug therapy ; epidemiology ; Time Factors ; Treatment Outcome ; Young Adult