Antivenom treatment and renal dysfunction in Russell's viper snakebite in Taiwan: a case series.
Formosan Russell's viper (Daboia russelli siamensis) is the sixth most frequent cause of snakebites in Taiwan. Its bite induces greater kidney injury than other Russell's vipers in Southeast Asia. Poor availability of antivenom might be the major reason. To enhance treatment, we supplied the antivenom to the teaching hospitals that are near the areas where D. r. siamensis is found. We also used an ELISA in diagnosis. From June 1999 to December 2001, a total of 13 cases of D. r. siamensis snakebite were diagnosed with serum venom level of 10-98 ng/ml, 1-6 hours after being envenomed. Abnormal coagulation function and acute renal failure occurred early and were the two most important clinical features. Early specific antivenom treatment, 3-6 hours after systemic envenoming, restored the coagulation function in 1-2 days and seemed to be statistically effective in reducing the severity of renal damage compared with the historical and delayed group by the Wilcoxon rank-sum test. Two to four vials of antivenom were needed to block the systemic toxicity and produced few side effects. The antivenom should be administered as early as possible to prevent systemic dysfunction.
Hung
Dong-Zong
DZ
Division of Toxicology, Emergency Department, Taichung Veterans General Hospital, No.160, Sec. 3, Taichung-Gang Road, Taichung 40705, Taiwan, ROC. hdz66@vghtc.gov.tw
Yu
Yi-Jung
YJ
Hsu
Chia-Lung
CL
Lin
Tzeng-Jih
TJ
D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000188:drug therapy / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017840:Daboia; D012909:Snake Bites / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D014757:Viper Venoms / Q000032:analysis*
D000997:Antivenins; D014757:Viper Venoms