title: Snakebite Envenoming by Sochurek's Saw-scaled Viper Echis Carinatus Sochureki.
abstract: A snake breeder, 47-years-old man, was bitten by the saw-scaled viper (Echis carinatus sochureki). After admission to Toxinology Centre, within 1.5 h, laboratory evaluation showed clotting times prolonged to non-measurable values, afibrinogenaemia, significantly elevated D-dimers, haemolysis and myoglobin elevation. Currently unavailable antivenom was urgently imported and administered within 10 hours. In 24 hours, oligoanuric acute kidney injury (AKI) and mild acute respiratory distress syndrome (ARDS) developed. Despite administration of 10 vials of urgently imported Polyvalent Snake Antivenom Saudi Arabia, the venom-induced consumption coagulopathy (VICC) and AKI persisted. Another ten vials of antivenom were imported from abroad. VICC slowly subsided during the antivenom treatment and disappeared after administration of total 20 vials during 5 day period. No signs of haemorrhage were present during treatment. After resolving VICC, patient was transferred to Department of Nephrology for persisting AKI and requirement for haemodialysis. AKI completely resolved after 20 days. Despite rather timed administration of appropriate antivenom, VICC and AKI developed and the quantity of 20 vials was needed to cease acute symptoms of systemic envenoming. The course illustrates low immunogenicity of the venom haemocoagulation components and thus higher requirements of the antivenom in similar cases.
authors.affiliation: Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic. valenta@vfn.cz.
authors.forename: Jiří
authors.initials: J
authors.lastname: Valenta
authors.affiliation: Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Zdeněk
authors.initials: Z
authors.lastname: Stach
authors.affiliation: Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Michálek
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests / Q000379:methods; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods; D012909:Snake Bites / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D014757:Viper Venoms / Q000633:toxicity*; D017819:Viperidae
chemical_list: D000997:Antivenins; D007155:Immunologic Factors; D014757:Viper Venoms
keywords: Antivenom; Coagulopathy; Echis pyramidum sochureki; Renal failure; Saw-scaled viper; Snakebite