Öz
Amaç:
Yılan zehirlenmeleri ciddi mortalite ve morbiditeye neden olabilir. Bu
çalışmada Acil Tıp Kliniğine yılan ısırması tanısı ile başvuran hastaların
hastaneye ulaşma süreleri, ısırılan bölgeleri, klinik evreleri, antivenom
ihtiyacı ve dozları, hastanede kalış süreleri arasındaki ilişki ve kan
biyokimyasındaki değişikliklerinin değerlendirilmesi amaçlandı.
Gereç ve Yöntem:
Çalışmamıza Mart 2011- Haziran 2013 tarihleri arasında Adana Numune Eğitim
Araştırma Hastanesi Acil Tıp kliniğine yılan ısırması şikayeti ile başvuran 34
hasta dahil edildi. Bu çalışmada Acil Tıp Kliniği’ne yılan ısırması tanısı ile
başvuran hastaların hastaneye ulaşma süreleri, ısırılan bölgeleri, klinik
evreleri, antivenom ihtiyacı ve dozları, hastanede kalış süreleri arasındaki
ilişki ve kan biyokimyasındaki değişiklikler değerlendirildi.
Bulgular:
Çalışmamızda Evre 0'da 9 (%26,5) hasta, Evre 1'de 5 (%14,7) hasta, Evre 2'de 17
(%50,0) hasta ve Evre 3'de 3 (%8,8) hasta olduğu saptandı. Klinik takiplerinde
24 saatten daha fazla süre hastanede kalan hastaların antivenom alma oranı ve
antivenom miktarı 24 saatten daha az hastanede kalanlardan anlamlı olarak daha
yüksekti. Çalışmamıza alınan hastalar evrelerine göre Evre 0-1 ve Evre 2-3
olarak iki gruba ayrılarak bu iki grubun aldıkları antivenom dozları
karşılaştırıldı. Evre 2-3 olan gruptaki hastaların aldıkları ortalama antivenom
dozu 4.15±2,06 iken, evre 0-1 grup hastalarda 1,83±1,17 olarak bulundu.
Sonuç: Yılan zehirlenmelerinde evrelemeye göre yüksek doz
antivenom tedavisi önerilse de öncelikli olarak anlık yüksek doz yerine düşük
doz antivenom tedavi ile başlanabilir ve klinik takibe göre ek doz antivenom
tedavi uygulanabilir.
Anahtar Kelimeler
Kaynakça
- 1. Kasturiratne A, Wickremasinghe AR, de Silva N. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med. 2008;5:e218.
- 2. Gold Barry S, Dart Richard C, Barish Robert A. Bites of Venomous Snakes New England Journal of Medicine. 2002; 347(5):347.
- 3. Russell FE. When a snake strikes. Emerg Med. 1990;22(12):33–43.
- 4. Mackessy SP. Biochemistry and pharmacology of colubrid snake venoms.Journal of Toxicology-Toxin Reviews. 2002;21(1):43-83.
- 5. Baran İ, Başoğlu M. Türkiye Sürüngenleri, Kısım 2, Yılanlar Ege Üniversitesi. Basımevi, İzmir, 1998:9-25.
- 6. Gökel Y, Başlamışlı F, Koçak R. Çukurova yöresinden yılan ısırmaları. Çukurova Üniversitesi Tıp Fakültesi Dergisi. 1997;22:184-8.
- 7. Warrell DA. Treatment of snakebite in the Assia Passific: A personal view. In: Gopalaksishnakone P, Chou LM, eds. Snake of medical importance singapore venom ad. Toxin Research Group. National University of Singapore. 1990;641-70.
- 8. Jarwani B, Jadav P, Madaiya M. Demographic, epidemiologic and clinical profile of snake bite cases. J Emerg Trauma Shock. 2013;6(3):199-202.
- 9. Heiner JD, Bebarta VS, Varney SM, Bothwell JD, Cronin AJ. Clinical Effects and Antivenom Use for Snake Bite Victims Treated at Three US Hospitals in Afghanistan. Wilderness Environ Med. 2013 Jul 16. doi: 10.1016/j.wem.2013.05.001. [Epub ahead of print].
- 10. McKinney EP. Out of hospital and interhospital management of crotaline snakebite. Annals of Emerg Med. 2001;37(2):168-75.
- 11. Michael GC, Thacher TD, Shehu MI. The effect of pre-hospital care for venomous snake bite on outcome in Nigeria. Trans R Soc Trop Med Hyg. 2011;105(2):95-101.
- 12. Al-Durihim H, Al-Hussaini M, Bin Salih S, Hassan I, Harakati M, Al Hajjaj A. Snake bite envenomation: experience at King Abdulaziz Medical City East. Mediatr Health J. 2010;16(4):438-41.
- 13. Roberts JR, Otten EJ. Snakebites and other reptiles. In: Goldfrank LR, ed. Goldfrenk’ s Toxicolojic Emergencies. Stamford, CT: Appleton & Lange,1998:1603-23.
- 14. Tagwireyi DD, Ball D, Nhachi C. Routine prophylactic antibiotic use in the management of snakebite. BMC Clinical Pharmacology. 2001;1(4).
- 15. Clark R F, Selden BS, Furbee B. The incidence of wound infection following crotalid envenomation. J Emerg Med. 1993;11:583-6.
- 16. Scharman E J, Noffsinger D V. Copperhead Snakebites: Clinical severity of local effects. Annals of Emergency Medicine. 2001; 38(1): 55-61.
- 17. Açikalin A, Gökel Y. Serum IL-6, TNFα levels in snakebite cases occurring in Southern Turkey. Emerg Med J. 2011 Mar; 28(3): 208-11.
- 18. Juckett G, Hancox G J. Venomous snakebites in the United States: Management review and update. Am Fam Physician. 2002;65:1367-74.
- 19. Ibister GK, Brown SG, MacDonald E, White J, Currie BJ. Australian Snakebite Project Investigators. Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis. Med J. 2008;188(8):473-6.
Demographic and Clinical Characteristics of Patients Presenting to the Emergency Department with Snakebite
Öz
Objective: Snake poisonings can cause severe morbidity and
mortality. In this study, it was aimed to evaluate arrival times of the
patients admitted to the Emergency Medicine Department with a diagnosis of
snakebite, bitten areas, clinical manifestations, the need for antivenom doses,
the relationship between the length of hospital stay and changes in blood
biochemistry.
Materials
and Methods: The total
number of 34 patients admitted to the Emergency Department of Adana Numune
Education and Research Hospital between March 2011 and June 2013 were included in
this study. In this study, arrival times of the patients admitted to the Emergency
Medicine Department with a diagnosis of snakebite, bitten areas, clinical
manifestations, the need for antivenom and their doses, the relationship
between the length of hospital stay and changes in blood biochemistry were
evaluated.
Results: In our study, 9 (26.5%) patients were grade 0, 5
(14.7%) patients, were grade 1, 17 (50.0%) patients were grade 2, 3 (8.8% )
patients were grade 3. In the clinical follow-up of the patients, the rate of
antivenom uptake and the amount of antivenom in patients stay in the hospital for
more than 24 hours were significantly higher than the ones that stay in the
hospital less than 24 hours. In our study, patients were divided into two
groups according to the stages with stage 0-1 and stage 2-3, and doses of
antivenoms that they take were compared. The mean dose of antivenom in the
group of patients with stage 2-3 was 4.15 ± 2.06, and this value was 1.83 ±
1.17 in patients with stage 0-1.
Conclusions: Despite high-dose antivenom therapy is recommended
snake poisonings according to the staging, low-dose antivenom therapy should be
considered instead of high-dose antivenom therapy and an additional dose of
antivenom could be used according to the clinical follow-up.
Kaynakça
- 1. Kasturiratne A, Wickremasinghe AR, de Silva N. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med. 2008;5:e218.
- 2. Gold Barry S, Dart Richard C, Barish Robert A. Bites of Venomous Snakes New England Journal of Medicine. 2002; 347(5):347.
- 3. Russell FE. When a snake strikes. Emerg Med. 1990;22(12):33–43.
- 4. Mackessy SP. Biochemistry and pharmacology of colubrid snake venoms.Journal of Toxicology-Toxin Reviews. 2002;21(1):43-83.
- 5. Baran İ, Başoğlu M. Türkiye Sürüngenleri, Kısım 2, Yılanlar Ege Üniversitesi. Basımevi, İzmir, 1998:9-25.
- 6. Gökel Y, Başlamışlı F, Koçak R. Çukurova yöresinden yılan ısırmaları. Çukurova Üniversitesi Tıp Fakültesi Dergisi. 1997;22:184-8.
- 7. Warrell DA. Treatment of snakebite in the Assia Passific: A personal view. In: Gopalaksishnakone P, Chou LM, eds. Snake of medical importance singapore venom ad. Toxin Research Group. National University of Singapore. 1990;641-70.
- 8. Jarwani B, Jadav P, Madaiya M. Demographic, epidemiologic and clinical profile of snake bite cases. J Emerg Trauma Shock. 2013;6(3):199-202.
- 9. Heiner JD, Bebarta VS, Varney SM, Bothwell JD, Cronin AJ. Clinical Effects and Antivenom Use for Snake Bite Victims Treated at Three US Hospitals in Afghanistan. Wilderness Environ Med. 2013 Jul 16. doi: 10.1016/j.wem.2013.05.001. [Epub ahead of print].
- 10. McKinney EP. Out of hospital and interhospital management of crotaline snakebite. Annals of Emerg Med. 2001;37(2):168-75.
- 11. Michael GC, Thacher TD, Shehu MI. The effect of pre-hospital care for venomous snake bite on outcome in Nigeria. Trans R Soc Trop Med Hyg. 2011;105(2):95-101.
- 12. Al-Durihim H, Al-Hussaini M, Bin Salih S, Hassan I, Harakati M, Al Hajjaj A. Snake bite envenomation: experience at King Abdulaziz Medical City East. Mediatr Health J. 2010;16(4):438-41.
- 13. Roberts JR, Otten EJ. Snakebites and other reptiles. In: Goldfrank LR, ed. Goldfrenk’ s Toxicolojic Emergencies. Stamford, CT: Appleton & Lange,1998:1603-23.
- 14. Tagwireyi DD, Ball D, Nhachi C. Routine prophylactic antibiotic use in the management of snakebite. BMC Clinical Pharmacology. 2001;1(4).
- 15. Clark R F, Selden BS, Furbee B. The incidence of wound infection following crotalid envenomation. J Emerg Med. 1993;11:583-6.
- 16. Scharman E J, Noffsinger D V. Copperhead Snakebites: Clinical severity of local effects. Annals of Emergency Medicine. 2001; 38(1): 55-61.
- 17. Açikalin A, Gökel Y. Serum IL-6, TNFα levels in snakebite cases occurring in Southern Turkey. Emerg Med J. 2011 Mar; 28(3): 208-11.
- 18. Juckett G, Hancox G J. Venomous snakebites in the United States: Management review and update. Am Fam Physician. 2002;65:1367-74.
- 19. Ibister GK, Brown SG, MacDonald E, White J, Currie BJ. Australian Snakebite Project Investigators. Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis. Med J. 2008;188(8):473-6.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Birinci Basamak Sağlık Hizmetleri |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Temmuz 2020 |
| Gönderilme Tarihi | 21 Eylül 2019 |
| Kabul Tarihi | 10 Ekim 2019 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 2 Sayı: 2 |
Cited By
The Role of Procalcitonin in Predicting Necessity of Antivenom Administration and Clinical Severity in Snake Bites
The Tohoku Journal of Experimental Medicine
https://doi.org/10.1620/tjem.2022.J037
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