Antivenom treatment and renal dysfunction in Russell's viper snakebite in Taiwan: a case series

Abstract

Formosan Russell's viper (Daboia russelli siamensis) is the sixth most frequent cause of snakebites in Taiwan. Its bite induces greater kidney injury than other Russell's vipers in Southeast Asia. Poor availability of antivenom might be the major reason. To enhance treatment, we supplied the antivenom to the teaching hospitals that are near the areas where D. r. siamensis is found. We also used an ELISA in diagnosis. From June 1999 to December 2001, a total of 13 cases of D. r. siamensis snakebite were diagnosed with serum venom level of 10-98 ng/ml, 1-6 hours after being envenomed. Abnormal coagulation function and acute renal failure occurred early and were the two most important clinical features. Early specific antivenom treatment, 3-6 hours after systemic envenoming, restored the coagulation function in 1-2 days and seemed to be statistically effective in reducing the severity of renal damage compared with the historical and delayed group by the Wilcoxon rank-sum test. Two to four vials of antivenom were needed to block the systemic toxicity and produced few side effects. The antivenom should be administered as early as possible to prevent systemic dysfunction.

Clinical and laboratory parameters associated with acute kidney injury in patients with snakebite envenomation: a prospective observational study from Myanmar

“…Previous studies reported similar factors associated with the sAKI, including receipt of antivenom >2 h after snakebite, cellulitis, hypotension, and rhabdomyolysis [9, 10, 13]. A previous case series from Taiwan showed that early specific antivenom treatment within 3 to 6 h after snake envenoming could restore coagulation abnormalities in 1 to 2 days and was effective in reducing the severity of renal damage [28]. …”

Evaluation of the geographical utility of Eastern Russell’s viper (Daboia siamensis) antivenom from Thailand and an assessment of its protective effects against venom-induced nephrotoxicity

“…For example, in Sri Lanka, some bites by D. russelii russelii have been reported to cause neurotoxicity characterized by flaccid paralysis, myotoxicity associated with skeletal muscle breakdown, and coagulopathy [30, 31]. In the case of D. siamensis , two of the most severe and common clinical outcomes observed following envenoming by this species are systemic coagulopathy and acute renal failure [7, 32]. Unfortunately, such signs are common when antivenom therapy is delayed or absent, and in a prior study resulted in over 70% of systemically envenomed Taiwanese victims presenting with thrombocytopenia, hemolysis and acute renal failure [33].…”

“…Prior in vivo experiments, which monitored renal hemodynamics in anaesthetised dogs, showed that purified PLA 2 and SVMP toxins from D. siamensis venom played an important role in causing renal vascular changes [20]. Furthermore, rapid increases in plasma BUN and creatinine levels appear to be useful markers for the diagnosis of Russell’s viper venom-induced acute renal failure [32]. In particular, elevation in plasma creatinine appears to be a significant biomarker indicating nephrotoxicity induced by snake envenomation.…”

A Study of Acute Kidney Injury in Patients with Snakebite Envenomation

“…Previous studies reported similar factors associated with the sAKI, including receipt of antivenom >2 h after snakebite, cellulitis, hypotension, and rhabdomyolysis [9,10,13] . A previous case series from Taiwan showed that early specific antivenom treatment within 3 to 6 h after snake envenoming could restore coagulation abnormalities in 1 to 2 days and was effective in reducing the severity of renal damage [28] .…”