Efficacy and Safety of Snake Antivenom Therapy: Experience of a Regional Hospital

Abstract

Snakebite is a commonly encountered envenomation emergency in the rural areas of Hong Kong. The majority of cases do not warrant antivenom therapy. We looked into those receiving antivenom to enhance the understanding of the results of antivenom therapy. Methods: This was a retrospective review of the snakebite cases treated with antivenom in Tuen Mun Hospital from 1st January 2000 to 31st August 2005, focusing on both the therapeutic and side effects of the antivenom. Results: Twelve patients were identified. All had local symptoms of swelling or numbness. Two of them subsequently developed skin necrosis requiring operative treatment. Thrombocytopenia was less amenable to correction than prolonged INR. No early or late allergic reactions were observed. Conclusion: Because of the small number of cases, the apparent safety of the antivenoms in the current review warrants larger trials in future.

A cross-sectional survey of snake oral bacterial flora from Hong Kong, SAR, China

“…Snake bite envenomation is a common medical emergency in Hong Kong1 2, with an incidence rate of 112 cases in the year 2008 according to hospital registration. Tuen Mun Hospital (TMH) is a regional emergency hospital of 1600 beds handling over 200 000 emergency cases annually.…”

“…The high human population density in close proximity to natural areas results in regular incidences of snakebites in humans. From January 2000 to August 2005, the hospital managed 192 snakebite cases 1. Wound infections account for 2–9% of snakebite cases 3–5.…”

“…Wound infections account for 2–9% of snakebite cases 3–5. Tissue necrosis results from the action of venom in snake envenomation by both the Chinese cobra ( Naja atra ) and the white-lipped pit viper ( Cryptelytrops albolabris ) in Hong Kong 1 2 6. This further complicates the infective process by providing an excellent medium for bacterial growth.…”

A Survey of Snakebite Management Knowledge Amongst Select Physicians in Hong Kong and the Implications for Snakebite Training

“…Only 52% of respondents identified C albolabris as exhibiting hemotoxic symptoms, reflecting the preponderance of cytotoxic symptoms and the relatively low level of systemic symptoms. 14…”

“…15,16 The appearance of coagulopathy in cases of C albolabris is uncommon but a key systemic sign of envenomation. 14,[17][18][19][20] The fact that nearly half of all respondents regard a confirmed krait bite alone as being grounds for administering ASV is significant ( Table 5). Presynaptic envenomation is almost universally accepted as not being ''reversible.''…”