title: Vipera berus bites in the Region of Southwest Poland--a clinical analysis of 26 cases.
abstract: 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.
authors.affiliation: Toxicological Unit, T Marciniak Hospital, Wrocław, Poland. naladgam@op.pl
authors.forename: Jan
authors.initials: J
authors.lastname: Magdalan
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Trocha
authors.forename: Anna
authors.initials: A
authors.lastname: Merwid-Lad
authors.forename: Tomasz
authors.initials: T
authors.lastname: Sozański
authors.forename: Marcin
authors.initials: M
authors.lastname: Zawadzki
mesh_terms: 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
chemical_list: D000997:Antivenins; D014757:Viper Venoms