독사교상후 발생한 급성신부전에 대한 임상적 고찰

백진기(Jin Ki Paek),유병우(Byung Woo Yu),안영수(Young Soo An),김종봉(Jong Bong Kim),김태준(Tae Jun Kim),김홍수(Hong Soo Kim),최태명(Tae Jun Kim),양동호(Dong Ho Yang),홍세용(Sae Yong Hong),양승하(Seung Ha Yang),이현순(Hyun Soon Lee) 대한내과학회 1994 대한내과학회지 Vol.46 No.4

N/A Objectives: The pathogenesis of acute renal failure developed after snake bite has been variously attributed to the direct renal damage by the venoms, and the secondary effects of disseminated intravascular coagulation, shock, intravascular hemolysis, the defibrination syndrome, and myoglobinuria. We analysed the thirteen cases of renal involvement after snake bite to elucidate possible causes and clinical characteristics of acute renal failure. Method: We reviewed the clinical symptoms, physical examination, laboratory data, and renal biopsies (two cases) in the 13 cases of acute renal failure developed after snake bite among 195 cases during the recent 10 years, Results: 1) The sex ratio of the patients with acute renal failure after snake bite (man: woman) was 1:5.5, presenting female predominance. Most of the cases were over 50 years of age covering more than 90% of the total snake bite cases 2) As respects to the time elapse from the snake bite to the hospital care, four cases were within 1 hour, two cases were within 1~2 hours, two cases were within 3~12 hours, and the rest of them (ten cases) were within 24 hours. 3) The systemic symptoms and signs of snake bite are as follows: nausea, vomiting, dyspnea, macroscopic hematuria, dizziness, headache, altered consciousness, and visual disturbance. Most of the patients complained of localized edema and pain around the wound of snake bite. Oliguria was noted in four patients, and it lasted for 13 days in average. 4) On admission, urinalysis of the patients with acute renal failure showed proteinuria (ten cases) and hematuria (six cases). Most of the patients with renal failure had hyperkalemia, hypocalcemia, elevated SGOT and LDH. The serum BUN and creatinine levels were elevated (more than 2.0 mg/dl and 4.2 mg/dl, respectively) above the normal range. 5) Renal biopsy performed in two cases of convalescent stage showed the findings of acute tubular necrosis with intact glomeruli. 6) Hemodialysis was performed in six patients out of thirteen cases of acute renal failure. 7) Of the thirteen patients with renal failure after snake bite, eight patients improved. But five patients were discharged against our will. All but one (self discharged) of the six patients with hemodialysis were discharged with clinical improvement. Conclusions: Acute renal failure caused by snake bite is not uncommon in Korea. We analysed the thirteen cases of snake bite with acute renal failure that revealed direct renal tubular necrosis on biopsy. And we speculate that the renal damage may be caused by the nephrotoxin of the venom. It is suggested that immediate intervention and preventive measures for renal failure after snake bite are needed.

Geographical distribution of health indicators related to snake bites and envenomation in Morocco between 1999 and 2013

Faiçal El Hattimy,Soulaymani Bencheikh Rachida 한국역학회 2018 Epidemiology and Health Vol.40 No.-

OBJECTIVES: Envenomation from snake bites is a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the epidemiological features of snake bites in Morocco and to evaluate time-space trends in snake bite incidence, the mortality rate, and the case-fatality rate. METHODS: This is a retrospective study of snake bite cases reported to the Moroccan Poison Control Center between 1999 and 2013. RESULTS: During the study period, 2,053 people were bitten by snakes in Morocco. Most victims were adults (55.4%). The average age of the patients was 26.48±17.25 years. More than half of the cases (58.1%) were males. Approximately 75% of snake bites happened in rural areas, and 85 deaths were recorded during this period. The incidence of snake bites remained generally steady over the 15-year period of this study, with a marked increase noted since 2012. The mortality rate has increased slightly, from 0.02 deaths per 100,000 inhabitants in 1999 to 0.05 in 2013. The geographical distribution of snake bite cases in the regions of Morocco showed that Tanger-Tétouan had the highest annual incidence of snake bites (1.41 bites per 100,000 inhabitants). However, the highest annual mortality rates were recorded in the Guelmim-Es Semara and Souss-Massa-Drâa regions (0.09 deaths per 100,000 inhabitants for both regions). CONCLUSIONS: The geographical distribution of the incidence, mortality, and case-fatality rates of snake bites in Morocco showed large disparities across regions during the three 5-year periods included in this study, meaning that certain areas can be considered high-risk for snake bites.

사교상 증례 분석과 임상적 고찰

홍순오,김태관,박훈기,이정권 한양대학교 의과대학 1999 한양의대 학술지 Vol.19 No.2

Venomous snake bite is an emergency accident that happens frequently in the farm land and mountain area from April to November. This study provides basic data that helps snake bite interventions in primary care and trys to explain the factors and the treatments that influence to prognosis of snake bites. We reviewed medical records about sex, age, residence place, date of snake bite, bitten place, site of wound, number of fangs, types of snakes, elapsed time to medical intervention, local symptoms, general symptoms, degree of snake bite, laboratory findings, treatment duration of hospitalization, and complication from 118 patients who visited emergency room of general hospital in Kyeongki-Do from 1994 to 1996. We retrospectively analysed medical records from 1994 to 1995, and investigated prospectively in 1996 through a structured questionnaire. Male and female ratio was 1.5:1 and most victims were in their sixth and seventh decades. No critical difference in annual distribution was found, while most cases occurred in July and August. The most frequent place of attack was the field(68%) and the most frequent site of wound was fingers(42%). Most patients did not know what kind of snakes were, but 10 patients knew that was Agkistrodon brevicaudus and one case was Agkistrodon saxatilis. The predominant local symtoms were pain and swelling, and systemic symptom was blurred vision. In laboratory findings, leukocytosis was present in 19 cases(21.6%), anemia in 19 cases(21.6%), thrombocytopenia in 38cases(42.2%), PT prolonged in 4 cases(4.6%), PTT prolongation in 5 cases(5.7%), ALT elevation in 8 cases(9.8%), AST elevation in 30 cases(36.6%), and pyuria in 8 cases(10.7%). The complications developed in 16 cases and one died of acute renal failure. Site of living, sex, age, bitten place, site of wound, usage of antibiotics, tetanus antitoxin, and polyvalent antivenin were not associated with duration of hospitalization and incidence of complications, but early treatment within 1 hour shortened duration of hospitalization significantly. Eighty-five patients(73%) were hospitalized and 59% of patients were treated with antivenin, but most patients showed mild clinical course. It is necessary ot educated about snake bite prophylaxis and early intervention because of better prognosis can be possible if snake bitten patients are treated within 1 hour.

독사교상의 합병증에 대한 연구

한병근(Byoung Geun Han),최승옥(Seung Ok Choi),김효열(Hyo Youl Kim),강남규(Nam Kyu Kang),류정선(Jeong Seon Ryu),이광훈(Kwang Hoon Lee) 대한내과학회 1996 대한내과학회지 Vol.50 No.3

N/A Objectives : We analyzed the clinical characteristics and complications of poisonous snake bite in Korea. Also we evaluated the causes of acute renal failure associated with poisonous snake bite. Methods: Fifty-eight patients with poisonous snake bite were included in this study. We reviewed and compared the clinical symptoms, physical examinations, and laboratory data of the complications that could be expected, such as rhabdomyolysis, disseminated intravascular coagulopathy and acute renal failure. Results: 1) The epidemiologic feature showed that most of the cases occurred from June to September, and the peak incidence of age was fifties and sixties. The snake distributions we studied were 12 cases(41.4%) of Agkistrdon blomhoffi brevicandus, 10 cases(34.5%) of A. saxatilis and 7 cases(24.1%) of A. caliginosus. 2) The systemic symptoms and signs were various. The most common complaints were nausea and vomiting. Most of the patients complained of localized edema and pain around the snake bite wound. 3) Generally, patients showed a mild clinical course but 2 cases were discharged hopelessly due to its complication accompanying acute renal failure. The complications of poisonous snake bite were rhabdomyolysis (32.7%), disseminated intravascular coagulopathy (29.3%), acute renal failure (8.6%) and hemolysis (1.7%). 4) A caliginosus was found to be the most common cause of the rhabdomyolysis induced by snake bite(p<0.05). Disseminated intravascular coagulopathy was mostly associated with A. blomhoffi brevicandus(p<0.05). 5) We believe that the secondary effects of fluid sequestration into the third space, rhabodmyolysis, disseminated intravascular coagulopathy and hemolysis play significant roles in acute renal failure associated with poisonous snake bite.

Ocular Manifestations of Venomous Snake Bite over a One-year Period in a Tertiary Care Hospital

Praveen Kumar K V,Praveen Kumar S,Nirupama Kasturi,Shashi Ahuja 대한안과학회 2015 Korean Journal of Ophthalmology Vol.29 No.4

Purpose: Ocular manifestations in snake-bite injuries are quite rare. However, the unusual presentations, diagnosis and their management can pose challenges when they present to the ophthalmologist. Early detection of these treatable conditions can prevent visual loss in these patients who are systemically unstable and are unaware of their ocular condition. To address this, a study was conducted with the aim of identifying the various ocular manifestations of snake bite in a tertiary care center. Methods: This is a one-year institute-based prospective study report of 12 snake bite victims admitted to a tertiary hospital with ocular manifestations between June 2013 to June 2014, which provides data about the demographic characteristics, clinical profiles, ocular manifestations, and their outcomes. Results: Twelve cases of snake bite with ocular manifestations were included of which six were viper bites, three were cobra bites and three were unknown bites. Six patients presented with bilateral acute angle closure glaucoma (50%), two patients had anterior uveitis (16.6%) of which one patient had concomitant optic neuritis. One patient had exudative retinal detachment (8.3%), one patient had thrombocytopenia with subconjunctival hemorrhage (8.3%) and two patients had external ophthalmoplegia (16.6%). Conclusions: Bilateral angle closure glaucoma was the most common ocular manifestation followed by anterior uveitis and external ophthalmoplegia. Snake bite can result in significant ocular morbidity in a majority of patients but spontaneous recovery with anti-snake venom, steroids and conservative management results in good visual prognosis.

독사 교상 환자에서의 음압요법; 예비보고

최환준,강상규,송우진 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.1

Purpose: Vaccum - assisted closure(VAC) has rapidly evolved into a widely accepted treatment of contaminated wounds, envenomations, infiltrations, and wound complications. This results in a sealed, moist environment where tissue is given the opportunity to survive as edema is removed and perfusion is increased. Many plastic surgeons now place a VAC device directly over the fasciotomy site at the time of the initial procedure. Large amounts of the fluid are withdrawn, and fasciotomies can be closed primarily sooner. This study was designed to observe the effect of VAC on preventing complications in snake bitten hands. Methods: In our study of three cases of snake bite, three of them underwent the VAC treatment & fasciotomy of the wound in the hand. This cases, the posterior compartment of the hand was bitten for a few days, releasing incisions were made of the posterior hand and 125 ㎜Hg of continuous vacuum was applied to fasciomy incision site and the biting wound. The dressings were changed three times per week. Results: Our study examining the effects of applied vacuum in preventing snake bite wounds showed that the incidence of tissue necrosis and compartment syndrome was significantly lower for vacuum - treated wounds than for conservative wounds. Serum myoglobin, CK - MB, and CPK levels measured after fasciotomy incision were significantly decreased. We obtained satisfactory results from early dorsal fasciotomy, drainage of the edema with the VAC system, and then primary closure. The postoperative course was uneventful. Conclusion: Envenomation is a term implying that sufficient venom has been introduced into the body to cause either local signs at the site of the bite and / or systemic signs. Use of the vacuum - assisted closure device in snake bite can result in a decreased rate of tissue necrosis, lymphatic fluid collection, hemolytic fluid collection, and edema. Early fasciotomy of the dorsal hand and VAC apply is the alternative treatment of the snake bite.

도시와 농촌에서 발생한 독사 교상 환자의 임상적 양상과 합병증 비교 연구

홍성준(Seong-Jun Hong),이주환(Joo-Hwan Lee),최우익(Woo-Ik Choi),진상찬(Sang-Chan Jin),전재천(Jae-Cheon Jeon) 한국농촌의학 지역보건학회 2020 농촌의학·지역보건 Vol.45 No.3

이 연구는 도시와 농촌에서 발생한 독사 교상환자의 임상적 특징과 합병증 발생의 차이를 비교하고자 시행하였다. 독사 교상으로 응급실에 내원한 18세 이상의 환자를 대상으로 2013년 1월부터 2019년 12월까지 7년간의 의무기록을 이용하여 조사하였다. 환자는 독사 교상이 발생한 지역에 따라 도시지역 그룹과 농촌지역 그룹으로 나누어 임상적 특성과 합병증을 비교하였다. 그 결과 전체 77명의 연구대상 중 44명(57.1%)이 농촌지역 그룹으로 조사되었다. 도시에서 발생한 독사 교상 환자보다 농촌지역 환자에서 평균 연령이 높았고, 중등도도 높았으며, 교상 장소에서 병원까지의 거리가 멀어 항뱀독소 치료를 포함한 응급처치 지연으로 급성 신기능 부전, 횡문근융해증, 혈액 응고 장애와 같은 합병증 발생이 많았다. 독사 교상에서 핵심이 되는 치료는 항뱀독소치료로 교상 후 가능한 빨리 투여하는 것이 중요하다. 증상이 진행한 후에 항뱀독소를 투여할 경우, 초기투여 시보다 더 많은 양의 항뱀독소 투여가 필요하다. 농촌은 의료 취약 지역으로 의료 접근성이 떨어지고 고령의 비율이 높아 상대적으로 나쁜 예후를 나타낸다. 따라서 이러한 문제해결을 위해서는 지방의 중소형 병원에서도 항뱀독소 이용이 가능하도록 해야 하며 그러지 못할때는 빠르게 대형 병원으로의 이송이 필요하다. Purpose: The purpose of this study is to compare the clinical features and complications of snake bite patients in urban and rural areas. Methods: A retrospective study was conducted on patients over 18 years of age who were hospitalized for snake bites from January 2013 to December 2019. Patients were categorized into urban and rural groups according to their respective locations at the time of the snake bite and the clinical characteristics and complications of the two patient groups were researched and compared. Results: Of the 77 snake bite patients, 44 patients were categorized into the rural group (57.1%). The rura1 group showed significant differences in old age (p=0.011), delayed hospital visits (p=0.010), far hospital distance (p<0.001), high local effect score (p<0.001), high traditional snake-bite severity grading scale (p=0.008) and use of large amounts of antivenins (p=0.026). There was a significantly higher incidence of acute kidney injury (p=0.030), rhabdomyolysis (p=0.026), and coagulopathy (p=0.033) in the rural group as well as a longer hospitalization period (p<0.011). Conclusion: Snake bites that occurred in rural areas resulted in patients with more complications compared to urban areas due to farther distances from hospitals, causing a delay in antivenom treatment.

독사교상 환자에서 응급 처치와 합병증의 연관성

전재천,이동하,권근용,김성진,Jeon, Jae-Cheon,Lee, Dong-Ha,Kwon, Geun-Yong,Kim, Sung-Jin 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.2

Purpose: There have been local wound complications in patients who have received first aid after venomous snake bites. Yet first aid in relation to local wound complications has not been well studied. Methods: We conducted a 5-year retrospective study of 111 snake bite patients who visited the emergency departments of several medical centers between January 2004 and December 2008. We categorized the patients into those who had complications with inadequate first aid, those who had complications without first aid those who had complications with adequate first aid. We compared the genera characteristics and the laboratory and clinical findings of the three groups. Results: The ale o female ratio was 1.36. The most common bite site was fingers. The most common systemic symptom was dizziness (6.3%) and the most common complication was rhabdomyolysis (23.4%). The inadequate first aids group had more local complications (cellulitis, skin necrosis) than did the group with adequate first aid or the group with no first aids. Conclusion: Inadequate first aid after snake bite leads to local complications, so we must be careful to administer first aid after snake bite and evaluate this first aid in elation to local complications.

소아중증 독사 교상 환자의 치험 1례

임치영,이정한,문태일,추용식,고대이,손석우,최성욱,김옥준 대한응급의학회 2004 大韓應急醫學會誌 Vol.15 No.2

임신 중 독사 교상 1례

김진주,현성열,양혁준,임용수,임혁기,김재광,이근 대한응급의학회 2009 대한응급의학회지 Vol.20 No.2

Snake bite during pregnancy is rare condition, and when it occurs there are two patients, mother and fetus. Timing is particularly important for pregnant women bitten by a snake. The earlier in the pregnancy the bite occurs, the more hazard to the fetus there is, and there are case reports of snake-bite-induced abortion and malformation of the fetus. The usefulness of antivenin during pregnancy is debatable. We report a case of snake bite during thirdtrimester pregnancy in a patient with general symptoms of envenomation and progressing edema in the bitten leg who was successfully treated with an emergency Caesarian section following the administration of antivenin.