4.4 Article

Complications of Bothrops, Porthidium, and Bothriechis snakebites in Colombia.: A clinical and epidemiological study of 39 cases attended in a university hospital

Journal

TOXICON
Volume 40, Issue 8, Pages 1107-1114

Publisher

PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/S0041-0101(02)00104-6

Keywords

Bothrops; envenomation; complications; Colombia

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The clinical and epidemiological features, as well as complications presented by 39 patients with Bothrops, Porthidium and Bothriechis snakebites, are described. Patients were admitted during 1 year in 25 hospitals of Antioquia and Choco and then, they were transferred to the Hospital Universitario San Vicente de Paul in Medellin, 30 of them because of the presence of complications, eight because of lack of antivenoms and another one because of the desire of his relatives. Thirty-one (79.5%) of the patients were male, 13 (33.3%) children, 59% of them were bitten at the lower extremities, the majority (74.4%) by Bothrops asper. Twenty-one (53.8%) of the patients were initially attended by traditional healers and sought medical attention at the local hospitals after 2 h in 87.2% of the cases. Edema (100%), hemorrhage (74.4%), blistering (38.5%) and necrosis (38.5%), were the local signs of envenomation, while blood coagulation alteration (79.5%), hematuria (74.4%), gingival bleeding (43.6%), hypovolemic shock (23.1%) and oliguria (23.1%), were the systemic signs of envenomation. The final grade of envenomation was severe in 29 patients (74.4%). Thirty patients (76.9%) had one or more complications of the envenomation: acute renal failure (ARF), 15 (38.5%); soft-tissue infection, 12 (30.8%); central nervous system (CNS) hemorrhage, 5 (12.8%); compartment syndrome, 3 (7.7%); soft-tissue hematomas, 6 (15.4%); and Abruptio placentae, one (2.6%). There were four deaths (10.3%), two from ARF and two from cerebral hemorrhage. Fourteen other patients (35.9%) had sequelae. The onset of serotherapy after 2 h of the bite was associated with the occurrence of ARF and CNS hemorrhage (p = 0.02), as well as the risk of death and sequelae (RR = 2.5). (C) 2002 Elsevier Science Ltd. All rights reserved.

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