Review of Treatment and Complications in 79 Children With Rattlesnake Bite

Abstract

Introduction Envenomation by snakebite is a health problem in Mexico.

Objective To review the treatment and complications of rattlesnake bites in 79 children.

Materials and methods The variables studied were age, sex, season, hour, signs, symptoms, and complications during 1977 to 1996 (group I) and 1997 to 2006 (group II). Hospitalization time and antivenom type, including polyvalent equine antiviperin serum and a [F(ab′)2] antivenom (fabotherapic), were also studied. Results. Most incidents (35%) occurred within the perimeter of children's homes and 8.8% took place inside homes; 40.5% of the children were females; and most snakebites occurred during the summer (70.8%). Members of groups I and II received polyvalent equine antiviperin serum and fabotherapy, respectively. Hospitalization time was less in group II members (P < .0001). The complications in group I members included hypoprothrombinemia and hypofibrinogenemia (P < .0001).

Conclusions Hospitalization time, complications, and treatment cost were less in patients undergoing fabotherapy.

Keywords

rattlesnake bite envenoming antiviperin serums fabotherapy hematologic complications

Get full access to this article

View all access options for this article.

References

Russell FE Snake Venom Poisoning. Philadelphia, PA : J. B. Lippincott; 1980:139-319.

Tay-Zavala J. , Díaz-Sánchez J. , Sánchez-Vega T. , et al. Serpientes y reptiles de importancia médica en México. Rev Fac Med UNAM . 2002;45:212-216.

Julia ZJ Reptiles mexicanos de importancia para la Salud Pública y su distribución geográfica. Salud Publica Mex. 1981;23:329-342.

Sotelo-Cruz N. Mordedura por serpiente venenosa. In: Martínez Panataleón O , ed. Intoxicaciones. Asociación Mexicana de Pediatría. México, DF: McGraw-Hill Interamericana; 2004:345-366.

Sotelo-Cruz N. , García-Alvarez R. Rattlesnake bite complications in 19 children. Pediatr Emerg Care. 1994;10: 30-33.

Roodt AR , Estevez-Ramírez J. , Paniagua-Solís JF , et al. Toxicidad de venenos de serpientes de importancia médica en México. Gac Med Mex. 2005;141:13-21.

Bjarnson JB , Fox JW Hemorrhagic metalloproteins from snake venom. Pharmacol Ther . 1994;63:325-331.

Gold SB , Barish RA , Dart CR North American snake envenomation: diagnosis and management. Emerg Med Clin North Am. 2004;22:423-443.

Sotelo-Cruz N. El tratamiento de la mordedura por serpientes. Un enfoque práctico. Rev Mex Pediatr. 1997 ; 64:33-39.

10.

Offerman SR , Smith T. , Derlet RW Does the aggressive use of polyvalent antivenin for rattlesnake bite result in serious acute side effects? West Med J. 2001;175:88-91.

11.

JMP [computer program]. Version 5.0.5 (Academic). Cary, NC: SAS Institute; 2004.

12.

Hines WH , Montgomery DC Probabilidad estadística para Ingeniería y Administración. 3rd ed. México: C.E.C.S.A. ; 1998:107-111.

13.

Dirección General de Planeación Tributaria. Cuotas aplicables a Servicios Médicos Asistenciales. Servicios de Administración Tributaria (SAT). México, DF: Secretaría de Hacienda y Crédito Público (SHCP); 1998.

14.

Christopher DG , Rodning CB Crotalidae envenomation. South Med J. 1986;79:159-162.

15.

Sotelo-Cruz N. , Cruz-Osuna L. Mordedura por serpiente de cascabel en niños . Bol Med Hosp Infant Mex. 1986;43:558-564.

16.

Sotelo-Cruz N. Envenenamiento por mordedura de serpiente de cascabel, daños a la salud y tratamiento en la edad pediátrica. Gac Med Mex. 2003;139:317-324.

17.

Corneille MG , Larson S. , Stewart RM , et al. A large single-center experience with treatment of patients with crotalid envenomations: outcome with and evolution of antivenin therapy. Am J Surg. 2006;192:848-852.

18.

Ozay G. , Bosnak M. , Ece A. , et al. Clinical characteristics of children with snakebite poisoning and management of complication in the pediatric intensive care unit. Pediatr Int. 2005;47:669-675.

19.

Owbny CL , Cameron DT , Tu AT Isolation of myotoxic component from a rattlesnake venom. Am J Pathol. 1976;85:149-153.

20.

Yarema MC , Curry SC Envenomation by the northern black tail rattlesnake (Crotalus molossus, molossus): a case report. Pediatr Emerg Care. 2005;21:40-42.

21.

Schmidt JM Antivenom therapy for snakebites in children. Is there evidence? Curr Opin Pediatr. 2005;17:234-238.

22.

Camilleri C. , Offerman S. , Gosselin R. , Alberston T. Conservative management of delayed, multicomponent coagulopathy following rattlesnake envenomation . Clin Toxicol (Phila). 2005;43:201-206.

23.

Boyer LV , Seifest SA , Cain JS Recurrence phenomena after immunoglobulin antivenom therapy for snake envenomation: Part 2. Guidelines for clinical management with crotaline fab antivenom. Ann Emerg Med. 2001;37:196-201.

24.

Dart RC , McNally J. Efficacy, safety and use snake antivenom in the United States. Ann Emerg Med. 2001;37:181-188.

25.

Seger D. , Kahn S. , Krenzelok EP Treatment of US crotalid bites. Comparison of serum and globulin-based polyvalent and antigen-binding fragment antivenins. Toxicol Rev. 2005;24:217-227.

26.

Richardon WH III , Tanen DA , Tong TC , et al. Crotalidae polyvalentimmune FAB (ovine) antivenom is effective in the neutralization of South American viperidae venoms in a murine model. Ann Emerg Med. 2005;45:595-602.

27.

Wasserberger J. , Ordog G. , Merkin TE Southern Pacific rattlesnake bite: a unique clinical challenge. J Emerg Med. 2006;31:263-266.

28.

Sánchez EE , Galán JA , Pérez JC , Rodríguez-Acosta A. , Chase BP , Pérez JC

The efficacy of two antivenoms against the venom of North

American snakes. Toxicon. 2003;41:357-365.

29.

García-Willis CE , Rivas-Castelón AR Experiencia en el manejo de pacientes con mordedura de víbora en el Hospital General de Tampico. Reporte de 210 casos. Med Int Mex. 1997;13:268-271.

30.

Frayre-Torres MJ , Sevilla-Godínez E. , Orozco-Valerio MDE , Armas J. , Celis A. Mortalidad por contacto con serpientes y lagartos venenosos en México de 1979-2003 . Gac Med Mex. 2006;42:209-213.