Vipera berus bites in the Region of Southwest Poland--a clinical analysis of 26 cases.
OBJECTIVE
Vipera berus is the only naturally occurring venomous snake in Poland. Its venom is primarily vasculotoxic and evokes both local and systemic findings. The aim of the study was to review a series of clinical cases of V berus bites occurring in southwest Poland.


METHODS
The charts of 26 patients (age range, 16-66 years; mean, 42 years) hospitalized with V berus bites were retrospectively analyzed using a data collection tool. Demographic and clinical data were extracted.


RESULTS
The most common local findings of envenomation were edema of the bitten limb with associated extravasations observed in 24 (92.3%) patients, but in only 1 (3.8%) case did the edema spread to the trunk. In 22 (84.6%) cases edema disappeared within 2 weeks after the bite. Systemic disturbances observed in the patients were: shock (1 case), mild transient hypotension (1 case), prolonged hypotension (3 cases), bronchospasm and laryngeal edema (1 case), diarrhea (1 case), transient supraventricular arrhythmias (2 cases), neutrophilic hyperleukocytosis (2 cases), and thrombocytopenia below 50000 cells/microL (5 cases). In 16 patients (61.5%) the envenomation was classified as moderate and this type was predominant. Six cases were classified as severe. No fatal case was reported. Treatment included the administration of specific antivenom in 14 cases (in all severe and half of moderate cases) and symptomatic treatment applied in all cases.


CONCLUSIONS
Moderate envenomation prevailed among the patients analyzed in the study. Antivenom treatment is primarily necessary in cases of severe (grade 3) and in some cases of moderate (grade 2) envenomation, especially in patients with persistent or recurring hypotension.
Magdalan
Jan
J
Toxicological Unit, T Marciniak Hospital, Wrocław, Poland. naladgam@op.pl
Trocha
Małgorzata
M
Merwid-Lad
Anna
A
Sozański
Tomasz
T
Zawadzki
Marcin
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011044:Poland / Q000453:epidemiology; D012720:Severity of Illness Index; D012909:Snake Bites / Q000150:complications / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome; D014757:Viper Venoms / Q000506:poisoning*; D017819:Viperidae; D055815:Young Adult
D000997:Antivenins; D014757:Viper Venoms