title: Venomous snake bites: clinical diagnosis and treatment.
abstract: Snake bites are life-threatening injuries that can require intensive care. The diagnosis and treatment of venomous snake bites is sometimes difficult for clinicians because sufficient information has not been provided in clinical practice. Here we review the literature to present the proper management of bites by mamushi, habu, and yamakagashi snakes, which widely inhabit Japan and other Asian countries. No definite diagnostic markers or kits are available for clinical practice; therefore, definitive diagnosis of snake-venom poisoning requires positive identification of the snake and observation of the clinical manifestations of envenomation. Mamushi (Gloydius blomhoffii) bites cause swelling and pain that spreads gradually from the bite site. The platelet count gradually decreases due to the platelet aggregation activity of the venom and can decrease to <100,000/mm(3). If the venom gets directly injected into the blood vessel, the platelet count rapidly decreases to <10,000/mm(3) within 1 h after the bite. Habu (Protobothrops flavoviridis) bites result in swelling within 30 min. Severe cases manifest not only local signs but also general symptoms such as vomiting, cyanosis, loss of consciousness, and hypotension. Yamakagashi (Rhabdophis tigrinus) bites induce life-threatening hemorrhagic symptoms and severe disseminated intravascular coagulation with a fibrinolytic phenotype, resulting in hypofibrinogenemia and increased levels of fibrinogen degradation products. Previously recommended first-aid measures such as tourniquets, incision, and suction are strongly discouraged. Once airway, breathing, and circulation have been established, a rapid, detailed history should be obtained. If a snake bite is suspected, hospital admission should be considered for further follow-up. All venomous snake bites can be effectively treated with antivenom. Side effects of antivenom should be prevented by sufficient preparation. Approved antivenoms for mamushi and habu are available. Yamakagashi antivenom is used as an off-label drug in Japan, requiring clinicians to join a clinical research group for its use in clinical practice.
authors: Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan.
authors: Toru
authors: T
authors: Hifumi
authors: The Japan Snake Institute, Yabuzuka 3318, Ota, Gunma, 379-2301 Japan.
authors: Atsushi
authors: A
authors: Sakai
authors: Department of Emergency Medicine, Graduate School of Medicine, University of the Ryukyus, 207, Uehara, Nishihara, Okinawa, 903-0215 Japan.
authors: Yutaka
authors: Y
authors: Kondo
authors: Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama, Tokyo, 208-0011 Japan.
authors: Akihiko
authors: A
authors: Yamamoto
authors: Okinawa Prefectural Institute of Health and Environment, 2085 Ozato, Ozato, Nanjo, Okinawa, 901-1202 Japan.
authors: Nobuya
authors: N
authors: Morine
authors: Department of Immunology, National Institute of Infectious Disease, Toyama 1-23-1, Shinjuku, Tokyo, 162-8640 Japan.
authors: Manabu
authors: M
authors: Ato
authors: Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama, Tokyo, 208-0011 Japan.
authors: Keigo
authors: K
authors: Shibayama
authors: Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
authors: Kazuo
authors: K
authors: Umezawa
authors: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, 190-0014 Japan.
authors: Nobuaki
authors: N
authors: Kiriu
authors: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, 190-0014 Japan.
authors: Hiroshi
authors: H
authors: Kato
authors: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, 190-0014 Japan.
authors: Yuichi
authors: Y
authors: Koido
authors: Division of Critical Care Medicine and Trauma, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimicho, Kofu, Yamanashi, 400-8506 Japan.
authors: Junichi
authors: J
authors: Inoue
authors: Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan.
authors: Kenya
authors: K
authors: Kawakita
authors: Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan.
authors: Yasuhiro
authors: Y
authors: Kuroda
keywords: Antivenom; Habu; Mamushi; Yamakagashi