Complete clinical course of envenomation by Protobothrops mangshanensis: delayed coagulopathy and response to Trimeresurus albolabris antivenom

Autor:	Daniel E. Keyler, Virginia Kubic, Travis D. Olives, Jill M. Topeff, Jon B. Cole, Laurie A. Willhite
Rok vydání:	2016
Předmět:	Adult Male 0301 basic medicine Emergency Medical Services food.ingredient Trimeresurus albolabris Antivenom Pain Snake Bites 030204 cardiovascular system & hematology Toxicology 03 medical and health sciences 0302 clinical medicine food Viperidae Animals Edema Humans Trimeresurus Medicine Protobothrops Blood coagulation test Prothrombin time biology medicine.diagnostic_test Antivenins business.industry Pit viper General Medicine Blood Coagulation Disorders biology.organism_classification Protobothrops mangshanensis Treatment Outcome 030104 developmental biology Anesthesia Disease Progression Blood Coagulation Tests business Partial thromboplastin time
Zdroj:	Clinical Toxicology. 54:290-292
ISSN:	1556-9519 1556-3650
DOI:	10.3109/15563650.2016.1138227
Popis:	Protobothrops mangshanensis, the Mangshan pit viper, is a rare pit viper native to the area surrounding Mount Mang in China's Hunan province. Toxicity from envenomation is not well characterized.A 33-year-old male presented to an emergency department (ED) after being bitten on the forearm by his P. mangshanensis. He complained of mild swelling and pain at the bite site. He was admitted for observation and toxicology consultation. Following initially normal coagulation studies including platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and D-dimer, fibrinogen decreased to 121 mg/dL and D-dimer concurrently rose to 377 ng/mL over 24 h. On hospital day 2 fibrinogen stabilized at 109 mg/dL and he was discharged with outpatient laboratory monitoring. Three days later, he returned with bruising to the contralateral arm. Fibrinogen was undetectable (40 mg/dL) and PT was 14.6 s. He declined admission but returned 2 d later with bruising to the nose. Bloodwork revealed immeasurably prolonged PT, aPTT, and thrombin time, but he eloped. Late that evening he returned and was treated with three vials of Green pit viper (Trimeresurus albolabris) antivenom. Within 24 h coagulopathy improved markedly; at five days, coagulation abnormalities resolved.Mangshan pit viper envenomations may cause isolated hemotoxicity, despite molecular studies suggesting additional neurotoxicity and myotoxicity. T. albolabris antivenom appears effective in treating the resultant coagulopathy.We report the natural history of envenomation by the Mangshan pit viper. A delayed coagulopathy, apparently fibrinolytic in nature, is unaccompanied by local tissue destruction and responsive to Green pit viper antivenom.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e26d3b6aba448995653f097173fdce3e https://doi.org/10.3109/15563650.2016.1138227 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
Nepřihlášeným uživatelům se plný text nezobrazuje	K zobrazení výsledku je třeba se přihlásit.