Management of Snakebite and Research Management of Snakebite ...
Management of Snakebite and Research Management of Snakebite ...
Management of Snakebite and Research Management of Snakebite ...
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PATIENTS AND METHODS<br />
Proven Russell’s viper bite patients with disseminated intravascular coagulation (DIC) entered<br />
into the study. Russell’s Viper envenomation was confirmed by identification <strong>of</strong> the dead<br />
snake <strong>and</strong>/or detection <strong>of</strong> specific venom antigen in serum by EIA (Khin-Ohn-Lwin et al.,<br />
1984, Tun-Pe et al., 1991). Patients under 12 <strong>and</strong> over 60 years <strong>and</strong> pregnant <strong>and</strong> lactating<br />
mothers were not included in the study. Patients were r<strong>and</strong>omly allocated to one <strong>of</strong> the<br />
following two treatment regimens:<br />
Regimen 1<br />
A single dose <strong>of</strong> 40 ml <strong>of</strong> ASV was given intravenously (IV) over 10 minutes. In those<br />
patients whose blood remained incoagulable six hours after the initial dose, another dose<br />
<strong>of</strong> 40 ml was given (IV over 10 minutes).<br />
Regimen 2<br />
A bolus dose <strong>of</strong> 80 ml <strong>of</strong> ASV (IV over 20 minutes). Lyophilized monovalent enzyme<br />
refined monospecific antivenom for Russell’s viper was used. Each individual patient was<br />
allocated to one <strong>of</strong> the above two regimens by lot.<br />
Analysis<br />
The two groups <strong>of</strong> patients were compared with respect to the patient’s characteristics,<br />
clinical features, progress, response <strong>and</strong> outcome. The patients under regimen one were<br />
carefully analysed to bring out the significant differences between those who needed 40<br />
ml only <strong>and</strong> those who required additional 40 ml. Statistical analysis was done by using<br />
student ‘’t’’ test (paired) <strong>and</strong> Chi square test.<br />
RESULTS<br />
Comparing regimens one <strong>and</strong> two<br />
A total <strong>of</strong> 45 patients were studied. 23 <strong>of</strong> them received regimen one <strong>and</strong> 22 patients<br />
received regimen two. Characteristics <strong>and</strong> clinical features <strong>of</strong> patients were shown in Tables<br />
1 <strong>and</strong> 2.<br />
Table 1. Characteristics <strong>of</strong> patients under<br />
two treatment regimens<br />
Regimen1 Regimen2<br />
Number <strong>of</strong> patients 23 22<br />
Average age (years) 36 37<br />
Sex ratio (male: female) 17:6 7:4<br />
Average weight (kg) 50 46<br />
Venom antigen levels (ng/ml)<br />
on admission Mean (range)<br />
71 (30-110) 85 (50-130)<br />
Interval between bite<br />
to antivenom<br />
(hours) Mean (range)<br />
Clinical <strong>Management</strong> <strong>of</strong> Russell’s Viper Bites<br />
4 (1-16) 3 (1.5-12)<br />
47
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