Treatment of poisonous snakebites in northern Taiwan

We evaluated the epidemiology and outcomes of snakebites in northern Taiwan, and the effect of local antivenom injection to speed neutralization and reduce the spread of venom.

We retrospectively reviewed the medical records of 130 venomous snakebite patients treated in a general hospital in northern Taiwan during a 3-year period (1991-1994). Patients received either combined local and intravenous injection of antivenom or intravenous administration only, according to the physicians' decision. The species of snake involved, time of bite, and outcome of the patient were recorded. The effect sof local and systemic antivenom administration were analyzed using the duration of emergency department (ED) stay among patients discharged from the ED with medical approval as a treatment index.

Most (76.1%) venomous snakebites were attributed to the green habu (68 patients) and the Taiwan habu (31 patients). All bites were to the extremities: 74 (57%) to the feet and 56 (43%) to the hands or arms. Most bites (n = 70, 53.9%) occurred between 2 PM and 9 PM. The peak months for snakebites were June through October (n = 84, 64.6%). Eighteen patients (13.8%) were admitted for further treatment after being cared for in the ED. The other 112 patients were discharged from the ED (86.2%), although three of these were admitted later because of infection. No patients died, but eight developed wound infections. Of the 93 patients discharged from the ED with medical approval, 26 (28.0%) received local injection plus systemic administration of antivenom. The duration of ED stay did not differ significantly between patients with local plus systemic administration and those who received systemic administration alone (23.7 +/- 19.5 hours vs 27.0 +/- 12.5 hours, p = 0.19).

Most snakebites in northern Taiwan were due to habus and caused mild symptoms. Local antivenom injection plus intravenous administration of antivenom had no benefit over intravenous administration alone.