Management of Snakebite and Research Management of Snakebite ...

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