Therapeutics and Clinical Risk Management (Nov 2021)

Malayan Pit Viper Envenomation and Treatment in Thailand

  • Tangtrongchitr T,
  • Thumtecho S,
  • Janprasert J,
  • Sanprasert K,
  • Tongpoo A,
  • Tanpudsa Y,
  • Trakulsrichai S,
  • Wananukul W,
  • Srisuma S

Journal volume & issue
Vol. Volume 17
pp. 1257 – 1266

Abstract

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Thunyaporn Tangtrongchitr,1,2 Suthimon Thumtecho,1,3 Jiratchaya Janprasert,4 Kitisak Sanprasert,2 Achara Tongpoo,1 Yuvadee Tanpudsa,1 Satariya Trakulsrichai,1,5 Winai Wananukul,1,6 Sahaphume Srisuma1,6 1Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Trauma and Emergency Medicine, Phramongkutklao Hospital, Bangkok, Thailand; 3Division of Toxicology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand; 4Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 5Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 6Division of Clinical Pharmacology and Toxicology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Sahaphume Srisuma Tel +66 2201 1682Email [email protected]: The Malayan pit viper (MPV; Calloselasma rhodostoma) is a hematotoxic snake found in all regions of Thailand and many countries in Southeast Asia. Treatment of MPV envenomation varies among facilities due to their capabilities.Materials and Methods: This study was a retrospective review of patients with MPV envenomation who were reported to the Ramathibodi Poison Center from 1 July 2016 to 30 June 2018.Results: Of the 167 patients (median age, 40.5 years; range, 1.3– 87.0 years) bitten by an MPV, the most common bite site was the foot (29.3%). Most patients reached the hospital within 1 hour of being bitten. One-hundred fifty-six patients (93.4%) had local effects from envenomation; 17 patients (10.2%) had severe local complications including necrotizing fasciitis (3.0%) and compartment syndrome (7.2%). Systemic effects such as hemorrhage and abnormal hemostasis occurred in 147 patients (88.0%). Additional effects included abnormal venous clotting time in 123 patients (73.7%), unclotted 20-minute whole blood clotting time in 57 patients (34.1%), low platelet counts ( 1.2) in 51 patients (30.5%), and systemic bleeding in 14 patients (8.4%). The median onset of bleeding disorder was 6 hours. Monitoring for 24, 48, and 49 hours after bite enabled detection of systemic effects in 94.2%, 99.3%, and 100.0%, respectively. Three hundred fifteen courses of antivenin were administered to 144 patients (86.2%). All the patients who received antivenin recovered from bleeding disorder. Only 7.0% of antivenin doses were administered without Thai Red Cross indications. Allergic reactions from antivenin occurred in 34.7% of the 144 patients. One hundred thirty patients (77.8%) received antibiotics, and 32 patients (19.2%) required surgical management, including debridement and fasciotomy.Conclusion: MPV envenomation results in local and systemic effects. Most systemic effects were abnormal clotting test results. Most patients reported onset of bleeding disorder within 48 hours.Keywords: Malayan pit viper, snake venom, hematotoxin, antivenin, onset of abnormality

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