Managing snakebite

Ralph, Ravikar; Faiz, Mohammad Abul; Sharma, Sanjib Kumar; Ribeiro, Isabela; Chappuis, François

doi:10.1136/bmj-2020-057926

Cited by 16 publications

(19 citation statements)

References 118 publications

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“…FHAV is effective for the P. mucrosquamatus -related systemic effect. However, P. mucrosquamatus bite resulted in many local tissue injuries, such as progressed edema, cyanosis, blister formation and wound necrosis [ 4 , 11 , 25 , 26 ]. Lin et al demonstrated the feasibility of using FHAV to reduce swelling in affected limbs [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…If patients bitten by P. mucrosquamatus develop blister formation or wound necrosis, debridement may be superior to increasing the volume of FHAV. To summarize, although antivenoms have been found to be effective in treating systemic envenoming resulting from snakebites, their effectiveness may be limited when it comes to treating the local tissue injuries [ 25 , 26 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

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Application of Sonographic Assessments of the Rate of Proximal Progression to Monitor Protobothrops mucrosquamatus Bite-Related Local Envenomation: A Prospective Observational Study

et al. 2023

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Patients bitten by Protobothrops mucrosquamatus typically experience significant pain, substantial swelling, and potentially blister formation. The appropriate dosage and efficacy of FHAV for alleviating local tissue injury remain uncertain. Between 2017 and 2022, 29 snakebite patients were identified as being bitten by P. mucrosquamatus. These patients underwent point-of-care ultrasound (POCUS) assessments at hourly intervals to measure the extent of edema and evaluate the rate of proximal progression (RPP, cm/hour). Based on Blaylock’s classification, seven patients (24%) were classified as Group I (minimal), while 22 (76%) were classified as Group II (mild to severe). In comparison to Group I patients, Group II patients received more FHAV (median of 9.5 vials vs. two vials, p-value < 0.0001) and experienced longer median complete remission times (10 days vs. 2 days, p-value < 0.001). We divided the Group II patients into two subgroups based on their clinical management. Clinicians opted not to administer antivenom treatment to patients in Group IIA if their RPP decelerated. In contrast, for patients in Group IIB, clinicians increased the volume of antivenom in the hope of reducing the severity of swelling or blister formation. Patients in Group IIB received a significantly higher median volume of antivenom (12 vials vs. six vials; p-value < 0.001) than those in Group IIA. However, there was no significant difference in outcomes (disposition, wound necrosis, and complete remission times) between subgroups IIA and IIB. Our study found that FHAV does not appear to prevent local tissue injuries, such as swelling progression and blister formation, immediately after administration. When administering FHAV to patients bitten by P. mucrosquamatus, the deceleration of RPP may serve as an objective parameter to help clinicians decide whether to withhold FHAV administration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Application of Sonographic Assessments of the Rate of Proximal Progression to Monitor Protobothrops mucrosquamatus Bite-Related Local Envenomation: A Prospective Observational Study

et al. 2023

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“…To maximise the efficacy of antivenom therapy, it is crucial for the antivenom to effectively bind to venom proteins before they disseminate to their intended target sites, where they can induce irreversible damage [ 32 ]. The timely administration of antivenom can yield significant benefits, including the mitigation of neurotoxic weakness, restoration of normal coagulation processes, and reduction of irreversible tissue damage caused by cytotoxins [ 3 , 32 , 33 , 34 ].…”

Section: Delays To Treatmentmentioning

confidence: 99%

“…Venom toxins can have systemic effects that affect several blood parameters, which can be measured. Baseline blood tests usually include a 20-min whole blood clotting time (20WBCT), a full blood count, urea and creatinine (kidney function) levels, coagulation parameters, and creatine kinase [ 34 ]. At a minimum, these tests can give clinicians a baseline profile of a patient’s blood composition and highlight any abnormalities.…”

Section: Blood Parametersmentioning

confidence: 99%

Clinical Risk Factors Associated with Poor Outcomes in Snake Envenoming: A Narrative Review

Wood

2023

Toxins

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Snakebite-related fatalities disproportionately affect populations in impoverished socio-economic regions, marked by limited access to adequate healthcare and constrained antivenom availability. Early medical intervention is pivotal in mitigating mortality and morbidity associated with snakebite envenoming (SBE). While clinical assessment remains fundamental in treating SBE, this review aims to spotlight objective parameters that could also affect outcomes. Selected studies that identify factors associated with poor outcomes are predominantly region-specific, single-site, and observational, yet collectively reveal similar findings. They consistently report factors such as treatment delays, susceptibility in vulnerable groups such as children and pregnant women, as well as various biochemical and haematological abnormalities. Acute kidney injury (AKI), low platelets, leucocytosis, abnormal coagulation, and elevated creatine kinase (CK) all show an association with poor outcomes. Furthermore, recognising rare and unusual SBE presentations such as adrenal insufficiency, severe hypertension, intracranial haemorrhage, acute angle closure glaucoma, and bowel ischaemia also has a bearing on outcomes. Despite the integration of these parameters into clinical decision tools and guidelines, the validation of this evidence is limited. This review underscores the imperative for high-quality, multi-centre studies aligned with consensus-driven Core Outcome Sets (COS) and Patient-Reported Outcome Measures (PROMS) to validate and strengthen the current evidence.

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“…The most efficient way to avoid snakebites is to have educational initiatives driven by the community and aimed at the people most likely to be bitten [55]. Utilizing radio, television, cell device apps, social networks, banners, magic shows, or public gatherings in smaller towns are all effective methods of communication that should be used [56].…”

Section: Preventionmentioning

confidence: 99%

Snakebite Envenoming: A Comprehensive Review on Epidemiology, Diagnosis, Potential Treatments Role of Proteomics and Bioinformatics

Alshammari¹

2022

Int J Pharm Res Allied Sci

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Since snakebite has been a medical problem for many decades, very little progress has been made in reducing the number of people who die. Snakebite kills millions of people worldwide each year, and many more are severely harmed. A wide range of bioactivities, including bleeding, inflammation, and discomfort, as well as cytotoxic, cardiotoxic, and neurotoxic effects, are involved in snake venom's envenomation. Numerous toxin-rich proteins may be found in the venomous snake species whose antivenoms collectively include hundreds of poisons. Despite extensive research efforts, most snake venom toxins are still unidentified. Recently developed bioinformatics techniques for mining snake venom have facilitated an experimental study on the most interesting potentially toxic substances. Several computational approaches can predict toxin molecular targets and the binding manner to these sites. Modern bioinformatics is utilized to examine snake venom proteins, in addition to the usage of herbs in their therapy is also discussed in this study. Efforts should be made to ensure the availability of safe and effective antivenoms in low-income tropical countries at reasonable rates and to ensure their correct clinical usage in these nations.

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Managing snakebite

Cited by 16 publications

References 118 publications

Application of Sonographic Assessments of the Rate of Proximal Progression to Monitor Protobothrops mucrosquamatus Bite-Related Local Envenomation: A Prospective Observational Study

Application of Sonographic Assessments of the Rate of Proximal Progression to Monitor Protobothrops mucrosquamatus Bite-Related Local Envenomation: A Prospective Observational Study

Clinical Risk Factors Associated with Poor Outcomes in Snake Envenoming: A Narrative Review

Snakebite Envenoming: A Comprehensive Review on Epidemiology, Diagnosis, Potential Treatments Role of Proteomics and Bioinformatics

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