Management of Snakebite and Research Management of Snakebite ...

Features and
symptoms Myinmu Kyauksae
Clinical Features of Russell’s Viper Bite Cases Admitted to Six Township Hospitals ...
Table 2. Local features and symptoms of Russell’s viper bite cases
Upper Myanmar Lower Myanmar
Taungdwingyi
Danu-phyu Yaekyi
Nyaunglaybin
Bruising % 5 13 27 23 23 6
Necrosis % - 13 10 9 4 6
Blackening % 14 7 - 45 4 6
Epigastric pain % - 55 27 68 23 47
Vomiting % 32 55 4 55 42 67
envenomed cases ranges from 20-26ng/ml (total range 10-50ng/ml) and systemic 61-71ng/
ml (total range 20-100ng/ml.) In 54% (37-67%) of the systemic envenomed cases, clot
restoration time takes 12hrs-48hrs. Pyrogen reactions are observed in 50%(21-82%) of the
antivenom treated cases.
Degree of
envenoming
Table 3. Degree of envenoming of the Russell’s viper bite cases*
Myinmu
n=43
Upper Myanmar Lower Myanmar
Kyauksae
n=24
Taungdwingyi
n=134
Danuphyu
n=31
Yaekyi
n=34
Nyaunglaybin
n=28
TOTAL
n=294
Non (%) 9 17 38 29 9 39 28%
Local (%) 72 21 28 13 15 7 29%
Systemic (%) 19 62 34 58 76 54 43%
Systemic +
Compli.(%)**
Venom level
(ng/ml)
Local enven.
Mean (range)
Systemic
enven.
Mean (range)
Clot
restoration
Time >6h%
Pyrogen
reaction %
*1/ 8 47 29 67 54 47 42%
23
(10-45)
64
(50-70)
67
(12-18h)
n=6
24
(10-40)
71
(55-100)
57
(12-48h)
n=14
26
(10-50)
61
(30-100)
37
(12-42h)
n=27
20
(10-40)
20
(10-40)
65.5
(20-100)
n=18
22
(10-30)
22
(10-30)
69
(50-100)
n=20
20
(20-)
64
(30-80)
50
(12-24h)
n=14
22.5
(10-50)
65.7
(20-100)
54%
(12- 48h)
n=99
21 (9/43) 67 (16/24) 50 (22/44) - - 82 (23/28) 50
(70/139)
* number of cases
** Calculation based on systemic cases
enven.=envenoming
Compli=complications
Development of systemic complications following the bites is shown in Table 4. In
general, systemic bleeding and complications are observed in all cases; however, some
features are more common in some localities such as gum bleeding, epistaxis, haemoptysis
37