title: Complications of Bothrops, Porthidium, and Bothriechis snakebites in Colombia. A clinical and epidemiological study of 39 cases attended in a university hospital.
abstract: The clinical and epidemiological features, as well as complications presented by 39 patients with Bothrops, Porthidium and Bothriechis snakebites, are described. Patients were admitted during 1 year in 25 hospitals of Antioquia and Chocó and then, they were transferred to the Hospital Universitario San Vicente de Paúl in Medellín, 30 of them because of the presence of complications, eight because of lack of antivenoms and another one because of the desire of his relatives. Thirty--one (79.5%) of the patients were male, 13 (33.3%) children, 59% of them were bitten at the lower extremities, the majority (74.4%) by Bothrops asper. Twenty-one (53.8%) of the patients were initially attended by traditional healers and sought medical attention at the local hospitals after 2h in 87.2% of the cases. Edema (100%), hemorrhage (74.4%), blistering (38.5%) and necrosis (38.5%), were the local signs of envenomation, while blood coagulation alteration (79.5%), hematuria (74.4%), gingival bleeding (43.6%), hypovolemic shock (23.1%) and oliguria (23.1%), were the systemic signs of envenomation. The final grade of envenomation was severe in 29 patients (74.4%). Thirty patients (76.9%) had one or more complications of the envenomation: acute renal failure (ARF), 15 (38.5%); soft-tissue infection, 12 (30.8%); central nervous system (CNS) hemorrhage, 5 (12.8%); compartment syndrome, 3 (7.7%); soft--tissue hematomas, 6 (15.4%); and Abruptio placentae, one (2.6%). There were four deaths (10.3%), two from ARF and two from cerebral hemorrhage. Fourteen other patients (35.9%) had sequelae. The onset of serotherapy after 2h of the bite was associated with the occurrence of ARF and CNS hemorrhage (p=0.02), as well as the risk of death and sequelae (RR=2.5).
authors.affiliation: Programa de Ofidismo, Facultad de Medicina, Universidad de Antioquia, AA 1226, Medellín, Colombia. rotero@epm.net.co
authors.forename: Rafael
authors.initials: R
authors.lastname: Otero
authors.forename: Johnayro
authors.initials: J
authors.lastname: Gutiérrez
authors.forename: María
authors.initials: M
authors.lastname: Beatriz Mesa
authors.forename: Edison
authors.initials: E
authors.lastname: Duque
authors.forename: Orlando
authors.initials: O
authors.lastname: Rodríguez
authors.forename: Jorge
authors.initials: J
authors.lastname: Luis Arango
authors.forename: Francisco
authors.initials: F
authors.lastname: Gómez
authors.forename: Alvaro
authors.initials: A
authors.lastname: Toro
authors.forename: Fidel
authors.initials: F
authors.lastname: Cano
authors.forename: Libia
authors.initials: L
authors.lastname: María Rodríguez
authors.forename: Erika
authors.initials: E
authors.lastname: Caro
authors.forename: José
authors.initials: J
authors.lastname: Martínez
authors.forename: William
authors.initials: W
authors.lastname: Cornejo
authors.forename: Luis
authors.initials: L
authors.lastname: Mariano Gómez
authors.forename: Francisco
authors.initials: F
authors.lastname: Luis Uribe
authors.forename: Silvia
authors.initials: S
authors.lastname: Cárdenas
authors.forename: Vitelbina
authors.initials: V
authors.lastname: Núñez
authors.forename: Abel
authors.initials: A
authors.lastname: Díaz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use; D000997:Antivenins / Q000009:adverse effects / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology / Q000382:microbiology; D017837:Bothrops; D002648:Child; D002675:Child, Preschool; D003105:Colombia / Q000453:epidemiology; D005260:Female; D006406:Hematoma / Q000188:drug therapy / Q000473:pathology; D006470:Hemorrhage / Q000139:chemically induced / Q000473:pathology; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests; D008297:Male; D008519:Medicine, Traditional; D008875:Middle Aged; D012909:Snake Bites / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology; D016896:Treatment Outcome; D017819:Viperidae
chemical_list: D000890:Anti-Infective Agents; D000997:Antivenins