Management of poisonous snake bites in southern Taiwan

Snake bite envenomation is not uncommon in Taiwan. This study focuses on the pattern of poisonous snake bites and their management in southern Taiwan over a 5-year period. The case histories of 37 patients with poisonous snake bites admitted to the Kaohsiung Medical University Hospital between June 2001 and July 2005 were analyzed retrospectively. Three patients, bitten by unknown species of venomous snakes, were excluded from this study. The frequency of snakebites from each species of snake, the local and systemic manifestations of snake bite, treatment of complications and final outcomes were analyzed. Of the remaining 34 patients, 11 (32.4%) were bitten by bamboo vipers, 10 (29.4%) by Russell's pit vipers, 8 (23.5%) by Taiwan cobras and 5 (14.7%) by Taiwan Habu. The majority of snake bites (28) occurred between May and November. Those affected were mainly outdoor hikers (14) and workers (9). The antivenin requirements for treatment in the emergency room were in accordance with standard procedures. No mortality was noted among those envenomed by poisonous snakes. Although poisonous snake bite is not a common life-threatening emergency in the study area, we observed both an environmental risk and a seasonal incidence of snake bite. Keeping the varied clinical manifestations of snake bite in mind is important for effective management. Ready availability and appropriate use of antivenin, close monitoring of patients, institution of ventilatory support and early referral to a larger hospital when required, all help reduce mortality.