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References Clinical Management of Russell’s Viper Bites (2) In patients with systemic bleeding and/or heavy proteinuria on admission, a bolus dose of 80 ml is recommended. (3) In patients who had received the initial dose of 40 ml, another 40 ml is recommended if blood fails to reclot six hours after the initial dose, or they develop systemic bleeding or proteinuria. Hla-Myint, Hla-Mon, Maung-Maung-Khin and Thet-Win. Snakebite and envenomation (1982). In:Internal medicine section BMA and envenomation. In: Internal medicine section BMA eds. Text book of Internal Medicine. Burma Medical Association, 16, p10. Khin-Ohn-Lwin, Aye-Aye-Myint, Tun-Pe, Theingie-Nwe and Min-Naing (1984). Russell’s viper venom levels in serum of snakebite victims in Burma. Transactions Royal Society Tropical Medicine and Hygiene, 78:165-168. Myint-Lwin, Warrell, DA, Phillips, RE., Tin-Nu-Swe, Tun-Pe, and Maung- Maung- Lay (1985). Bites by Russell’s viper (V.russelli siamensis) in Burma: Haemostatic, vascular and renal disturbances and response to treatment. Lancet, ii: 1259-1264. Tun-Pe and Khin-Aung-Cho (1986). Amount of venom injected by Russell’s viper (Vipera russelli). Toxicon, 24: 730-733. Tun-Pe, Ba-Aye, Aye-Aye-Myint, Tin-Nu-Swe and Warrell, D.A.(1991). Bites by Russell’s viper (Daboia russelii siamensis) in Myanmar: effect of the snake’s length and recent feeding on venom antigenaemia and severity of envenoming. Transactions of Royal Society of Tropical Medicine and Hygiene, 85:804-808. 51
Management of Snakebite and Research 52 Management of Acute Renal Failure Following Russell’s Viper Bite at the Renal Medical Unit, Yangon General Hospital Tin-Shwe 1 and Paing-Soe 2 1 Consultant Nephrologist, Renal Medical Unit, Yangon General Hospital 2 Prof. and Head of Renal Medical Unit, Yangon General Hospital Abstract Bites by the snakes of viperidae family are a common occurrence in Myanmar, and their clinical course is often complicated by acute renal failure. As our unit is a tertiary referral centre, most of the cases came in with established acute renal failure with advanced uraemia often with severe complications such as septicaemia, DIC and other organ failure. As a developing country with limited resources for extracorporeal renal replacement therapy (RRT) we have to rely on acute peritoneal dialysis which is an invaluable therapeutic tool. Out of 101 patients admitted in a one year period, 68 patients (67.3%) had to undergo dialytic therapy and 26 patients (25.7%) recovered with optimal conservative therapy without RRT. Seven patients signed and left because of profound severity of their illness with very slim chances of recovery. Dialytic therapy had to be provided on the fifth or sixth day of postviper bite. Mortality was 30% and, the causes of death were septicaemia 41% and myocardial failure 34%. INTRODUCTION Snakebite is a common occurrence in rural Myanmar and if adequately treated by specific antivenom in time and carefully monitored, the mortality could be virtually nil. Renal failure is a common event following a bite by Russell’s viper, a common snake found in Myanmar. The study aims to assess the magnitude of renal failure following Russell’s viper bite, timing for initiation of dialytic therapy, its indications and complications, and the main causes of morality. Brief discussions about pathogenetic mechanism, renal histological changes encountered and conservative therapy are included. MATERIALS AND METHODS This is a retrospective study. All cases of viper snakebite admitted in the renal medical ward of Yangon General Hospital over a one year period between December 2000 and
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