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Influential factors affecting prognosis of snakebite patients management: Kaohsiung Chang Gung Memorial Hospital
1Department of Emergency Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C.
Insights
This study identifies Trimeresurus stejnegeri as the most common cause of snakebites. T. mucrosquamatus frequently leads to acute renal failure, while Bungarus multicinctus causes respiratory failure.
Area of Science:
- Clinical Toxicology
- Emergency Medicine
- Herpetology
Background:
- Snakebite envenomation presents a significant public health challenge.
- Identifying key prognostic factors is crucial for effective patient management.
Purpose of the Study:
- To determine the most influential factors affecting snakebite patient prognosis.
- To analyze the types of snakebites and their associated complications.
Main Methods:
- Retrospective review of poisonous snakebite cases from June 1986 to November 1999.
- Analysis of snake species, envenomation type, and patient outcomes.
Main Results:
- Trimeresurus stejnegeri (70%) was the most common cause of hemorrhagic snakebites.
- T. mucrosquamatus was linked to acute renal failure, and B. multicinctus to respiratory failure.
- Inadequate antivenin dosage for cobra bites correlated with severe skin necrosis.
Conclusions:
- Trimeresurus stejnegeri bites are most frequent; T. mucrosquamatus causes renal issues; B. multicinctus causes respiratory failure.
- Suboptimal antivenin treatment for cobra bites resulted in severe complications.
- Effective snakebite management requires accurate species identification and appropriate antivenin administration.
Background:
The objective of this study was to determine the most influential factors affecting the prognosis of snakebite patients in Kaohsiung Chang Gung Memorial Hospital.
Methods:
A thorough review of the medical records of poisonous snakebite from June 1986 to November 1999 was carried out in this retrospective study.
Results:
Of the identified snakes in 39 bite victims, 70% of these cases were hemorrhagic type: Trimeresurus stejnegeri 20/27, T. mucrosquamatus 6/27, and Agkistrodon acutus 1/27; 28% were neurotoxic type: Naja naja atra 6/11 and Bungarus multicinctus 5/11; and 2% was mixed type: Vipera russelli formosensis 1/39. Three of four acute renal failure victims were bitten by T. mucrosquamatus. Two of the 5 victims bitten by B. multicinctus required endotracheal intubation to maintain their respiration. Five patients received skin grafting, 3 of whom were bitten by Naja naja atra. Most of our patients (55%) received only a single dose of antivenin, and 83% (29/35) of the antivenin was given within 6 hours after the bite; the antivenin infusion was finished in less than 2 hours in most cases (33/36).
Conclusion:
Bites from Trimeresurus stejnegeri are the most common poisonous snakebite recorded in our emergency department. T. mucrosquamatus is prominent in causing bleeding tendency and acute renal failure. Bungarus multicinctus is more prominent than Naja naja atra in causing acute respiratory failure. The dosage of antivenin used to treat patient bitten by cobra was less than that recommended by the poison control center, and the complication of skin necrosis requiring skin grafting was more severe than that of the other species.