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Crotalid envenomation in children: selective conservative management
1University of Arkansas for Medical Sciences, Little Rock.
Insights
Snake bites in children are rare, and conservative treatment is often effective. Antivenin use in pediatric snakebites should be cautious due to high rates of serum sickness.
Area of Science:
- Pediatric Medicine
- Toxicology
- Emergency Medicine
Background:
- Snake bites in children represent an uncommon yet significant clinical challenge.
- Therapeutic approaches to pediatric snakebites lack uniform consensus among experts.
- This study reviews institutional experience with pediatric snakebite management.
Purpose of the Study:
- To evaluate the outcomes of conservative management for snake bites in children.
- To assess the risks and benefits of antivenin and cryotherapy in pediatric snakebite patients.
- To advocate for a selective and conservative treatment strategy.
Main Methods:
- Retrospective review of 29 children treated for snake bites with signs of envenomation over 5 years.
- Standardized treatment included laboratory studies, IV fluids, tetanus prophylaxis, antibiotics, and supportive care.
- Analysis of outcomes, including fasciotomy, cryotherapy complications, and antivenin reactions.
Main Results:
- No deaths occurred among the 29 pediatric patients.
- Three children required fasciotomy; cryotherapy resulted in tissue loss in one case.
- Seven children received antivenin, all experiencing serum sickness; conservative management was successful for most, including copperhead bites.
Conclusions:
- The majority of pediatric snake bites, particularly copperhead bites, can be managed conservatively with good outcomes.
- Antivenin administration in children is associated with a high incidence of adverse reactions (serum sickness).
- Cryotherapy is contraindicated due to its potential to increase morbidity and cause tissue damage.
Abstract:
Snake bites in children remain an uncommon injury. In general, there is a wide disagreement by knowledgeable authorities on a uniform approach to therapy. In the last 5 years, 29 children have been treated in our institution for snake bites, all with signs of envenomation. Treatment consisted of diagnostic laboratory studies, intravenous fluids, tetanus prophylaxis, antibiotics, bed rest, elevation, and observation. There were no deaths. A fasciotomy was required in three children. Cryotherapy initiated elsewhere resulted in tissue loss. Seven children received antivenin. All developed signs and symptoms to serum sickness. From this experience, it appears that the majority of snake bites in children, especially copperhead bites, can be treated selectively and conservatively. Care must be exercised in using antivenin as it is associated with a high rate of serum sickness. Cryotherapy adds to the morbidity of the bite and is not to be used.