Snake bite

Substance

Protobothrops mucrosquamatus (龜殼花) 50% [1]

Trimeresurus stejnegeri Schmidt (赤尾青竹絲) 7% [1]

Deinagkistrodon acutus (百步蛇)

Bungarus multicinctus (雨傘節)

Naja atra (眼鏡蛇)

Daboia siamensis (鎖鏈蛇)

Common name or Trade name

 
龜殼花 -- 烙鐵頭 ,筍殼班, 老鼠蛇, 惡烏子

赤尾青竹絲 -- 赤尾鮐, 青竹蛇, 青竹鏢

 

百步蛇 -- 尖吻蝮, 尖吻蝮蛇, 五步蛇, 蘄蛇

雨傘節 -- 寸白蛇, 台灣環蛇, 中國環蛇, 過基甲, 過基峽, 簸箕甲, 手巾蛇, 銀

腳帶, 銀環蛇, 金錢蛇, 銀蛇, 花扇柄, 雨傘柄, 小白藥蛇, 台灣克雷特.

 

眼鏡蛇 -- 飯匙倩, 飯匙銃, 飯鏟頭, 膨頸蛇, 五毒蛇.

 
鎖鏈蛇 -- 七步紅

 

Involving system and Presentation

 

Hematotoxic – hours to days, up to 3 days. [2]

Neurotoxic – minutes to hours. (less than 12 hours.) [2].

 

Dry bite (10%) in a Thailand report. [3]

龜殼花, 赤尾青竹絲, 百步蛇 – pain, ecchymosis with swelling, bullae formation

百步蛇 – coagulopathy. Bleeding tendency. Epistaxis. DIC.

雨傘節, 眼鏡蛇 - lethargy，numbness rather than ecchymosis / swelling，weakness/ paralysis, diplopia, blurred vision, ptosis, dysarthria. Drooling, respiratory failure.

眼鏡蛇—severe painful, swelling, tissue necrosis, rhabdomyolysis.  

鎖鏈蛇 – ecchymosis, swelling, bullae formation. Hemolysis, and rhabdomyolysis, acute renal failure, lung edema.   

Antidote and Treatment

(H)青竹絲 總量1—4 vials. 視病況需要調整用量 (大部份1 vial, 轉診來的3vials,有開刀的 3 vials). 平均2.8 Vials. [1]

 (H)龜殼花 總量4.5 vials. 視病況需要調整用量. [1]


   百步蛇 總量1—4 vials. 視病況需要調整用量


 
 (N)眼鏡蛇 總量6—12vials 視病況需要調整用量(大部份1vial, 轉診來的4.5vials有開刀的 8.5 vials) , weakness就開始給 [2]
 
 (N)雨傘節 總量1—4 vials. 視病況需要調整用量, weakness就開始給 [2]

 鎖鏈蛇 總量1—4 vials. 視病況需要調整用量


 
Disposition and Outcome

 
Comparment syndrome 13.6%. [1]

Surgical intervention 22% [1]

Adverse drug reaction to antivenom reaches 3—53% in a Thailand report. [3].

Admission if symptoms progressive although/ even antivenom administrated.

If hemodynamic change / AMS : admit to ICU.

References

 

[1] 2019 International Conference for Poison Control and Research Development. 2019; Nov 15—17, p.191.

 

[2]. 2019 International Conference for Poison Control and Research Development. 2019; Nov 15—17, p.211--6.

 

[3] 2019 International Conference for Poison Control and Research Development. 2019; Nov 15—17, p.205.

-- 20th, March, 2020. Yu-Jang Su