Acidente por serpentes do gênero Bothrops: série de 3.139 casos

Abstract

Medical records of 3,139 patients bitten by Bothrops snakes and attended at Vital Brazil Hospital (HVB) from 1981 to 1990 were reviewed. They were more frequent in males (75.7%). In 1,412 cases (45.0%) the snake was classified by species, and 1,376 were B. jararaca, 20 B. jararacussu, 11 B. neuwiedi, 2 B. moojeni, 2 B. alternatus e 1 B. pradoi. The most frequent bitten anatomic regions were: foot (47.5%) and hand (21.3%). Tourniquet was used in 38.2% of the cases and its frequency fell down during the study period (p < 0.05). The clinical features at the bite site were: pain (95.6%), swelling (95.4%), ecchymosis (56.1%), blisters (13.8%), necrosis (16.5%), and abscess (11.0%). Systemic manifestations were: bleeding (12.3%), acute renal failure (1.6%), and shock (0.7%). There were blood coagulation disorders in 1,730 (57.9%) of the 2,990 cases. There were 21 amputations (0.7%) and 9 deaths (0.3%). The average serum dose that was used in treatment fell down during the study period (p < 0.001).

Accidentes ofídicos en Yopal y Leticia, Colombia, 1996-1997

“…Los estudios de Bucaramanga, Antioquia, Chocó y Cauca muestran que entre el 0 y el 8% de los accidentados presentó amputación, cifras similares a las encontradas en el estudio. Sin embargo, los datos de estudios en Brasil muestran un porcentaje de amputaciones que oscila entre el 0 y el 2,3%, lo cual nos señala un peor pronóstico de los accidentes ocurridos en el país, posiblemente por el tratamiento tardío y deficiente o por las características del veneno de las serpientes brasileras (1,2,13,14,16,17,19,20).…”

“…De lo anterior podemos concluir que los estudios con series de casos bajas pueden mostrar una letalidad alta, lo cual podría explicar el margen tan diverso en los diferentes estudios hechos en el país, de los cuales el valor de letalidad más valioso fue el encontrado por Otero et al en una serie de casos de 244 accidentes, en la cual el porcentaje de fallecimientos fue de 3%. Por consiguiente, es importante realizar estudios de casos más amplios, en los que el dato de letalidad tenga una mayor representación (1)(2)(3)6,16,17,20).…”

Insuficiência múltipla de órgãos relacionada a acidente ofídico: relato de caso

“…(5) A study of 3,139 Bothrops accidents reported acute renal failure in 1.6% of the cases. (6) Its genesis involves several mechanisms, as rhabdomyolysis, intravascular coagulation and direct nephrotoxins action. (7) Additionally, other factors associated with acute renal failure are age (more frequent in children), snake size, bite site, patient's hydration, and the time between the bite and the specific serum administration.…”

“…(3,4,9) The mortality rate is low, around 0.5% of the cases, and the type of poisoning and time to therapy may increase mortality up to 8 folds. (1,(3)(4)(5)(6)9) This report aims the description of an ophidian accident case, caused by a Bothrops gender snake, involving ARDS and MOSF, as well as to discuss the therapeutic approach.…”

Fatores associados à incoagulabilidade sangüínea no envenenamento por serpentes do gênero Bothrops

“…Distúrbios funcionais permanentes e até mesmo a perda do membro acometido podem ocorrer 21 31 34 42 . O distúrbio da coagulação é, provavelmente, a manifestação sistêmica mais comum que, às vezes, exterioriza-se clinicamente por sangramentos distantes dos ferimentos causados pelos dentes inoculadores 42 . O óbito ocorre em casos de envenenamentos graves em pacientes que apresentam insuficiência renal, respiratória e choque 37 .…”