Acute and Critical Care

Original Article

Trauma
Risk factor, monitoring, and treatment for snakebite induced coagulopathy: a multicenter retrospective study: Yong Jun Jeon, Jong Wan Kim, SungGil Park, Dong Woo Shin; Acute Crit Care. 2019;34(4):269-275. Published online November 18, 2019; DOI: https://doi.org/10.4266/acc.2019.00591; Correction in: Acute Crit Care 2020;35(1):56

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Background
Snakebite can cause various complications, including coagulopathy. The clinical features of snakebite-associated coagulopathy differ from those of disseminated intravascular coagulation (DIC) caused by other diseases and its treatment is controversial.
Methods
We retrospectively reviewed the medical records of patients hospitalized for snakebite between January 2006 and September 2018.
Results
A total of 226 patients were hospitalized due to snakebite. Their median hospital stay was 4.0 days (interquartile range, 2.0 to 7.0 days). Five patients arrived at hospital with shock and one patient died. Twenty-one patients had overt DIC according to the International Society of Thrombosis and Hemostasis scoring system. Two patients developed major bleeding complications. Initial lower cholesterol level at presentation was associated with the development of overt DIC. International normalization ratio (INR) exceeding the laboratory’s measurement limit was recorded as late as 4 to 5 days after the bite. Higher antivenom doses (≥18,000 units) and transfusion of fresh frozen plasma (FFP) or cryoprecipitate did not affect prolonged INR duration or hospital stay in the overt DIC patients without bleeding.
Conclusions
Initial lower cholesterol level may be a risk factor for overt DIC following snakebite. Although patients lack apparent symptoms, the risk of coagulopathy should be assessed for at least 4 to 5 days following snakebite. Higher antivenom doses and transfusion of FFP or cryoprecipitate may be unbeneficial for coagulopathic patients without bleeding.

Citations

Citations to this article as recorded by

A simple mortality risk prediction score for viper envenoming in India (VENOMS): A model development and validation study
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The effect of myocardial injury on the clinical course of snake envenomation in South Korea
J. M. Moon, Y. J. Koo, B. J. Chun, K. H. Park, Y. S. Cho, J. C. Kim, S. D. Lee, Y. R. Min, H. S. Park
Clinical Toxicology.2021; 59(4): 286. CrossRef

Case Report

Splenic Hemorrhage with Hemoperitoneum Caused by a Snakebite: Ji Young Yhi, Yoomi Yeo, Ji Yeoun Kim, Il Hwan Oh, Soon Woo Hwang, Sang Ki Lee, Dong Shin Kwak, Ji Yoon Choi, Jeong Eun Kim, Joon Sung Park; Korean J Crit Care Med. 2013;28(4):336-339.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.336

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Abstract PDF

In Asia, snakebites are estimated to affect 4 million people every year, and of these, 100,000 people are estimated to die. In Korea, snakebites occur frequently from the spring to the fall, but their importance is often overlooked. Fatal complications, including acute respiratory distress and acute kidney injury, can occur, and in some cases, severe hemorrhage results from coagulopathy. There have been only a few cases of snakebite-induced liver or intestinal bleeding, but to our knowledge, spontaneous bleeding from the spleen has not been previously reported. Here, we report the case of a 61-year-old male who visited the emergency room with abrupt abdominal pain due to hemoperitoneum associated with splenic hemorrhage after a snakebite.

Citations

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Toxicon.2024; 237: 107350. CrossRef
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Medical Biological Science and Engineering.2024; 7(1): 64. CrossRef
Delayed Splenic Rupture: A Rare Complication of Snakebites
Tae-Youn Kim, Young-Il Roh, Kyoung-Chul Cha, Sung Oh Hwang, Woo Jin Jung
Wilderness & Environmental Medicine.2021; 32(1): 78. CrossRef
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Toxicon.2021; 204: 9. CrossRef

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