title: Neurological Involvement and Hepatocellular Injury Caused by a Snake With Hematotoxin Envenomation.
abstract: Venomous snakes with hematotoxin-Russell's viper (Daboia spp), Malayan pit viper (Calloselasma rhodostoma), and green pit viper (Cryptelytrops albolabris and C macrops, previously named Trimeresurus spp) are commonly found in Thailand. Coagulation factor activation, thrombocytopenia, hyperfibrinolysis, and disseminated intravascular coagulation are the main mechanisms of hemorrhaging from these snake bites. The neurological involvement and hepatocellular injury after Russell's viper bites were reported in Sri Lanka, but there is no report from Southeast Asia. This case was a 12-year-old hill tribe boy who had ptosis and exotropia of the left eye, respiratory distress, and prolonged venous clotting time, prothrombin time, and activated partial thromboplastin time; low fibrinogen and platelet count; and transaminitis after being bitten by a darkish-colored snake. He did not respond to antivenom for cobra, Malayan pit viper, or Russell's viper. However, his neurological abnormalities, respiratory failure, and hepatocellular injury improved, and coagulopathy was finally corrected after receiving antivenom for green pit viper. The unidentified snake with hematotoxin was alleged for all manifestations in this patient.
authors.affiliation: Department of Pediatrics (Drs Sontichai, Reungrongrat, and Natesirinilkul).
authors.forename: Watchareewan
authors.initials: W
authors.lastname: Sontichai
authors.affiliation: Department of Pediatrics (Drs Sontichai, Reungrongrat, and Natesirinilkul).
authors.forename: Sanit
authors.initials: S
authors.lastname: Reungrongrat
authors.affiliation: Department of Forensic Medicine (Dr Narongchai), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Paitoon
authors.initials: P
authors.lastname: Narongchai
authors.affiliation: Department of Pediatrics (Drs Sontichai, Reungrongrat, and Natesirinilkul). Electronic address: rungrote.n@cmu.ac.th.
authors.forename: Rungrote
authors.initials: R
authors.lastname: Natesirinilkul
mesh_terms: D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D001763:Blepharoptosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002648:Child; D005099:Exotropia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008099:Liver / Q000201:enzymology; D008297:Male; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012206:Rhabdomyolysis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D017840:Daboia; D012909:Snake Bites / Q000145:classification / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D013785:Thailand; D000637:Transaminases / Q000378:metabolism
chemical_list: D000997:Antivenins; D000637:Transaminases
keywords: coagulopathy; exotropia; hepatocellular injury; neurological abnormality; ptosis; snake bite