Venomous Snakebites

Abstract

More than 5 million people are bitten by venomous snakes annually and more than 100 000 of them die. In Europe, one person dies due to envenomation every 3 years. There is only one venomous snake species in Lithuania – the common adder (Vipera berus) – which belongs to the Viperidae family; however, there are some exotic poisonous snakes in the zoos and private collections, such as those belonging to the Elapidae family (cobras, mambas, coral snakes, etc.) and the Crotalidae subfamily of the Viperidae family (pit vipers, such as rattlesnakes). Snake venom can be classified into hemotoxic, neurotoxic, necrotoxic, cardiotoxic, and nephrotoxic according to the different predominant effects depending on the family (i.e., venom of Crotalidae and Viperidae snakes is more hemotoxic and necrotoxic, whereas venom of Elapidae family is mainly neurotoxic). The intoxication degree is estimated according to the appearance of these symptoms: 1) no intoxication (“dry” bite); 2) mild intoxication (local edema and pain); 3) moderate intoxication (pain, edema spreading out of the bite zone, and systemic signs); 4) severe intoxication (shock, severe coagulopathy, and massive edemas). This topic is relevant because people tend to make major mistakes providing first aid (e.g., mouth suction, wound incision, and application of ice or heat). Therefore, this article presents the essential tips on how first aid should be performed properly according to the “Guidelines for the Management of Snake-Bites” by the World Health Organization (2010). Firstly, the victim should be reassured. Rings or other things must be removed preventing constriction of the swelling limb. Airway/breathing must be maintained. The bitten limb should be immobilized and kept below heart level to prevent venom absorption and systemic spread. Usage of pressure bandage is controversial since people usually apply it improperly. Incision, mouth suction, or excision should not be performed; neither a tourniquet nor ice or heat should be applied. A doctor must monitor respiratory rate, blood pressure, heart rate, renal function, fluid balance, and coagulation status. The only specific treatment method is antivenin – serum with antibodies against antigens of snake venom. Antivenins against pit vipers used in the United States are Antivenin Crotalidae Polyvalent (ACP) and a more purified and hence causing less adverse reactions – Crotalidae Polyvalent Immune Fab (CroFab). In Europe, a polyvalent antiserum against Viperidae family snakes (including the common adder) can be used. Antivenins often may cause severe hypersensitivity reactions because of their protein nature. The bite of the common adder (the only poisonous snake in such countries as Lithuania and Great Britain) relatively rarely results in death; thus, considering the risk of dangerous reactions the antivenin causes itself, the usage of it is recommended to be limited only to life-threatening conditions.

ACUTE KIDNEY INJURY CAUSED BY Crotalus AND Bothrops SNAKE VENOM: A REVIEW OF EPIDEMIOLOGY, CLINICAL MANIFESTATIONS AND TREATMENT

“…The patient should be placed in a comfortable position, with the affected limb elevated at the heart's level1.…”

“…The adverse effects of anti-ophidic sera are: type I acute reactions, due to reactions of circulating immunoglobulin E to horse proteins; anaphylactoid reactions due to direct degranulation of mastocytes and serum sickness (a late allergic reaction caused by immune complexes)1.…”

The identification of bacterial flora in oral cavity of snakes

“…Annually, 1.22 to 5.5 million cases, out of which 125,000 cases lead to death or disability, has been reported. Most mortality happens in the southeast part of Asia (Kasturiratne et al 2008;Adukauskienė et al 2010;Rita et al 2011). Only in Asia, it is estimated that 4 million cases happen annually.…”

A Study of Acute Kidney Injury in Patients with Snakebite Envenomation

“…Thus, capillary permeability increases, albumins escape to the perivascular space, tissue oncotic pressure increases, and plasma oncotic pressure decreases, resulting in a shift of fluid balance from the intravascular to interstitial space, or capillary leakage. The decrease in intravascular volume may be sufficiently severe to compromise circulation, resulting in shock [32] . In cases of severe envenomation, snake venom can induce the release of auto pharmacological vasoactive substances, particularly bradykinin, resulting in vasodilatation and myocardial depression, and consequently reduce myocardial contractility [32] .…”

“…The decrease in intravascular volume may be sufficiently severe to compromise circulation, resulting in shock [32] . In cases of severe envenomation, snake venom can induce the release of auto pharmacological vasoactive substances, particularly bradykinin, resulting in vasodilatation and myocardial depression, and consequently reduce myocardial contractility [32] . Therefore, our findings support the pathophysiology of sAKI as multifactorial, including hemodynamic changes, direct toxicity of snake venom, immunologic reaction and pigmenturia [33] .…”