title: Envenoming after a snakebite from the Northeast African saw-scaled viper Echis pyramidum: prolonged therapy upon failed treatment by antivenom.
abstract: A reptile holder based in the Czech Republic was bitten into his hand             and foot by the Northeast saw-scaled viper (Echis pyramidum). The person arrived             at the health institution after twenty hours for anuria. Despite the antivenom             against the Asian Echis carinatum - the Echis pyramidum's close relative - was             readily available and administered repeatedly, the envenoming continued to develop             with subsequent coagulopathy, hepatopathy and respiratory failure. The effects             of plasmapheresis and symptomatic therapy were positive, but only temporary.             Continual renal replacement therapy and plasmapheresis were complicated by             thrombotic occlusions of the device tubing set. A turning point arrived following             repeated application of imported antivenom containing antigens against venom             components of another African saw-scaled viper species, Echis leucogaster (the             antivenom containing E. pyramidum antigens was not available). The clinical             status, including complications, resolved following 30 days of hospitalization. The              case further validates the geographical specifics of immunogenicity of venom components              with similar clinical action in snakes of the same genus.
authors: Department of Anesthesiology and Intensive Care, Charles University, Prague, Czech Republic. jiri.valenta@vfn.cz
authors: J
authors: J
authors: Valenta
authors: Z
authors: Z
authors: Stach
authors: M
authors: M
authors: Kolář
mesh_terms: D000328:Adult; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012909:Snake Bites / Q000628:therapy*; D017211:Treatment Failure; D017819:Viperidae
chemical_list: D000997:Antivenins