Hump-nosed viper bite is the commonest venomous snakebite in Sri Lanka. Acute kidney injury (AKI) in association with coagulopathy is an important cause of mortality. Immunomodulating effects of fresh frozen plasma (F...Hump-nosed viper bite is the commonest venomous snakebite in Sri Lanka. Acute kidney injury (AKI) in association with coagulopathy is an important cause of mortality. Immunomodulating effects of fresh frozen plasma (FFP) could block the nephrotoxic effects of venom;and by replenishing depleted clotting factors resulting from venom induced consumption coagulopathy could offer an additional benefit in offsetting renal injury triggered by haematological disturbances. In a non-randomised observational study carried out from 2005 to 2008 in adults at the National hospital of Sri Lanka, the mean time for resolution of coagulopathy among 42 patients treated with FFP at the inception of coagulopathy was 4.7 hours compared to 18 patients treated with isotonic Saline among whom the mean time for normalisation of coagulopathy was 6.2 hours. None of these 60 patients developed acute renal failure. A separate cohort of 32 patients with coagulopathy after hump-nosed viper bite who had not received FFP during this study period developed acute renal failure and required haemodialysis. In the absence of safe and effective antivenom for hump-nosed viper in Sri Lanka, FFP may be a therapeutic option. FFP if given early to selected patients at inception of coagulopathy may prevent AKI and serve to save lives after hump-nosed viper bites.展开更多
Objective:To identify the clinical manifestations of hump nosed viper envenomation and to recognize the available treatment methods to prevent complications.Methods:Descriptive observational study involving a series o...Objective:To identify the clinical manifestations of hump nosed viper envenomation and to recognize the available treatment methods to prevent complications.Methods:Descriptive observational study involving a series of 1 543 patients admitted with hump nosed viper bite to 5 major hospitals in Sri Lanka was conducted.Data collection was done consecutively during February 1990 and February 2008.Except Hypnale,identification of the biting snake was made by the corresponding author after visual examination of the dead or live snakes,which were brought to hospital.Results:Sixty seven(4.34%) patients developed systemic effects and two (0.1%) patients died due to effects of envenomation or complications of treatment.Systemic effects varied from coagulopathy,nephropathy to some neurological manifestations.Fifty nine (3.8%) patients had only coagulopathy and they received either,intravenous isotonic saline to ensure adequate urine out put i.e.0.5 mL/kg /hour or 15 mL/kg of fresh frozen plasma(FFP). None of the patients that had coagulopathy developed renal failure.Contamination of the sample by mildly venomous species of Hypnale may have contributed to the low incidence of systemic complications.Conclusions:It is likely that early hydration with normal saline or FFP can prevent acute renal failure.FFP showed a tendency for early correction of coagulopathy.Role of FFP in hump nosed viper envenomation is worth studying in randomized double blind controlled clinical trials.展开更多
Objective:To describe the epidemiology of snake bite in the region and attempt to compare proven Russell’s viper with hump-nosed viper bites.Methods:All snake bite admissions to the Toxicology Unit of Teaching Hospit...Objective:To describe the epidemiology of snake bite in the region and attempt to compare proven Russell’s viper with hump-nosed viper bites.Methods:All snake bite admissions to the Toxicology Unit of Teaching Hospital Peradeniya over three year from 2006 were included. Results:Of the 776 snakebites,665(86%) were unidentified and non-envenomed.Humpnosed viper and Russell’s viper accounted for 55(7%) and 40(5%) bites respectively,of them, incriminated snakes were found in 36(65%) and 19(48%) cases.The cobra bites-5,krait bites-0. The median ages:Russell’s viper bites-41(range 16-66),hump-nosed viper bites-42(range 15- 75).The gender incidence,time of bite(】58%daytime) were similar.In hump-nosed viper bite; upper limb involved in 13(36%),happened at home garden in 22(61%),none in paddy fields.In Russell’s viper bite;6(33%) occurred in paddy fields.Dry bites were similar at 5%.In humpnosed viper bite:local effects 94%,coagulopathy 3%,acute renal failure 3%and one patient died.In Russell’s viper bite;local effects 84%,coagulopathy 53%,neurotoxicity 21%.Abdominal pain occurred only in Russell’s viper bites 10(53%).Conclusions:Overwhelming numbers of unidentified,non-envenomed snakebites are common in the central hills.Some distinctive differences were observed between Russell’s viper and hump-nosed viper bites.展开更多
文摘Hump-nosed viper bite is the commonest venomous snakebite in Sri Lanka. Acute kidney injury (AKI) in association with coagulopathy is an important cause of mortality. Immunomodulating effects of fresh frozen plasma (FFP) could block the nephrotoxic effects of venom;and by replenishing depleted clotting factors resulting from venom induced consumption coagulopathy could offer an additional benefit in offsetting renal injury triggered by haematological disturbances. In a non-randomised observational study carried out from 2005 to 2008 in adults at the National hospital of Sri Lanka, the mean time for resolution of coagulopathy among 42 patients treated with FFP at the inception of coagulopathy was 4.7 hours compared to 18 patients treated with isotonic Saline among whom the mean time for normalisation of coagulopathy was 6.2 hours. None of these 60 patients developed acute renal failure. A separate cohort of 32 patients with coagulopathy after hump-nosed viper bite who had not received FFP during this study period developed acute renal failure and required haemodialysis. In the absence of safe and effective antivenom for hump-nosed viper in Sri Lanka, FFP may be a therapeutic option. FFP if given early to selected patients at inception of coagulopathy may prevent AKI and serve to save lives after hump-nosed viper bites.
文摘Objective:To identify the clinical manifestations of hump nosed viper envenomation and to recognize the available treatment methods to prevent complications.Methods:Descriptive observational study involving a series of 1 543 patients admitted with hump nosed viper bite to 5 major hospitals in Sri Lanka was conducted.Data collection was done consecutively during February 1990 and February 2008.Except Hypnale,identification of the biting snake was made by the corresponding author after visual examination of the dead or live snakes,which were brought to hospital.Results:Sixty seven(4.34%) patients developed systemic effects and two (0.1%) patients died due to effects of envenomation or complications of treatment.Systemic effects varied from coagulopathy,nephropathy to some neurological manifestations.Fifty nine (3.8%) patients had only coagulopathy and they received either,intravenous isotonic saline to ensure adequate urine out put i.e.0.5 mL/kg /hour or 15 mL/kg of fresh frozen plasma(FFP). None of the patients that had coagulopathy developed renal failure.Contamination of the sample by mildly venomous species of Hypnale may have contributed to the low incidence of systemic complications.Conclusions:It is likely that early hydration with normal saline or FFP can prevent acute renal failure.FFP showed a tendency for early correction of coagulopathy.Role of FFP in hump nosed viper envenomation is worth studying in randomized double blind controlled clinical trials.
文摘Objective:To describe the epidemiology of snake bite in the region and attempt to compare proven Russell’s viper with hump-nosed viper bites.Methods:All snake bite admissions to the Toxicology Unit of Teaching Hospital Peradeniya over three year from 2006 were included. Results:Of the 776 snakebites,665(86%) were unidentified and non-envenomed.Humpnosed viper and Russell’s viper accounted for 55(7%) and 40(5%) bites respectively,of them, incriminated snakes were found in 36(65%) and 19(48%) cases.The cobra bites-5,krait bites-0. The median ages:Russell’s viper bites-41(range 16-66),hump-nosed viper bites-42(range 15- 75).The gender incidence,time of bite(】58%daytime) were similar.In hump-nosed viper bite; upper limb involved in 13(36%),happened at home garden in 22(61%),none in paddy fields.In Russell’s viper bite;6(33%) occurred in paddy fields.Dry bites were similar at 5%.In humpnosed viper bite:local effects 94%,coagulopathy 3%,acute renal failure 3%and one patient died.In Russell’s viper bite;local effects 84%,coagulopathy 53%,neurotoxicity 21%.Abdominal pain occurred only in Russell’s viper bites 10(53%).Conclusions:Overwhelming numbers of unidentified,non-envenomed snakebites are common in the central hills.Some distinctive differences were observed between Russell’s viper and hump-nosed viper bites.
