Acute Kidney Injury and Rhabdomyolysis After Protobothrops flavoviridis Bite: A Retrospective Survey of 86 Patients in a Tertiary Care Center

Abstract

Abstract. Acute kidney injury (AKI) is the main cause of death for victims of hematoxic snakebites. A few studies have described improvement in AKI rates in snakebite cases, but the reasons for the improvement have not been investigated. Eighty-six patients with Protobothrops flavoviridis bites admitted to a single center from January 2003 through March 2014 were included in the study. Clinical variables, including age, sex, blood pressure (BP), and serum creatinine (S-Cre), on admission were compared between patients with and without AKI. One patient died of disseminated intravascular coagulation following AKI (mortality rate 1.1%). Six patients developed AKI with rhabdomyolysis. Systolic BP, S-Cre, serum creatine kinase, white blood cell count, and platelet count differed significantly between the AKI and non-AKI groups (P = 0.01). Three of the six patients were physically challenged to a degree that made it difficult for them to move or communicate, and these difficulties likely exacerbated the severity of snakebite complications. Our study demonstrated that the risk of snakebite-induced AKI for physically challenged patients was high. To further reduce mortality due to snakebite-induced AKI, we need to make it possible for physically challenged patients to receive first aid sooner.

Habu coagulotoxicity: Clinical implications of the functional diversification of Protobothrops snake venoms upon blood clotting factors

“…Consistent with the extreme variation in their venoms, Protobothrops species are highly variable in morphology and ecological niche occupied, ranging from heavily built terrestrial species (eg P. mangshanensis) to gracile semi-arboreal species (eg P. flavoviridis). While the venom variation is suggestive of this feature being a driver in their adaptive radiation, it is also indicative of the potential to produce differential clinical effects, in that while haemorrhagic shock may be produced by all (Chen et al, 2009;Nishimura et al, 2016), the underlying mechanics may be different.…”

“…The wide-ranging Asian pit viper genus Protobothrops occupies the islands of Japan, mainland China and islands off China, with the occupation of diverse ecological niches mirrored by diverse morphology. Protobothrops bites are known for potent haemorrhagic shock effects in prey and human bite victims (Chen et al, 2009;Nishimura et al, 2016).…”

Clinical Serum Therapy: Benefits, Cautions, and Potential Applications

“…43 Recently, Nishimura et al reported 86 cases of habu bites from 2003 to 2014 in Amami Ohshima, a known habu habitat in Kagoshima prefecture. 44 Good clinical outcomes were reported in this area, with 97.7% (84/86 patients) receiving antivenom therapy and a mortality rate of only 1.1% (1/86 cases). In contrast, the mortality rate reported in the same area in 1978 was 10%.…”

A blood bond: evolutionary, pathophysiological and biodiscovery implications of coagulotoxic snake venoms

“…Consistent with the extreme variation in their venoms, Protobothrops species are highly variable in morphology and ecological niche occupied, ranging from heavily built terrestrial species (eg P. mangshanensis) to gracile semi-arboreal species (eg P. flavoviridis). While the venom variation is suggestive of this feature being a driver in their adaptive radiation, it is also indicative of the potential to produce differential clinical effects, in that while haemorrhagic shock may be produced by all Nishimura et al, 2016), the underlying mechanics may be different.…”

“…The wide-ranging Asian pit viper genus Protobothrops occupies the islands of Japan, mainland China and islands off China. Protobothrops bites are known for potent haemorrhagic shock effects in prey and human bite victims Nishimura et al, 2016). Target sites include impeding primary haemostasis by disruption along the cascade from the blockage of platelet aggregation through to inhibiting clot formation due to the unnatural cleavage of fibrinogen (Collet et al, 2000;Kolev and Longstaff, 2016;Longstaff and Kolev, 2015;Mosesson, 2005).…”