Acute renal failure after snakebite: a report of four cases

There is risk of acute renal failure (ARF) after snakebite. Four patients are reported who developed ARF after bites by Vipera russelli formosensis. The four patients were all male, of ages ranging from 26 to 55 years old. Their clinical features were mainly hemorrhage including hemoptysis, hematemesis, gross hematuria and hypotension. The abnormal laboratory data were thrombocytopenia, prothrombin time (PT) and activated partial thromboplastin time (APTT) prolongation, disseminated intravascular coagulation (DIC), hemolysis and rhabdomyolysis. The onset of ARF occurred within 24 hours after the snakebite, and lasted for 17 to 26 days. All patients received conservative treatment including hemodialysis and antivenin therapy. One patient, with massive gastrointestinal bleeding, died. It was concluded that the factors contributing to ARF following Vipera russelli formosensis bit are hemorrhage, hypotension, DIC, hemolysis and rhabdomyolysis. To prevent development of ARF, the early administration of antivenin cannot be too strongly emphasized.