ABSTRACT
Sao analisados tres pacientes que apresentaram comprometimento da funcao respiratoria apos acidente por Crotalus durissus. As manifestacoes respiratorias surgiram nas primeiras 48 horas apos a picada do ofidio e consistiram de dispneia, taquipneia, uso da musculatura acessoria da respiracao (casos 1 e 2) e batimento das aletas nasais (caso 2). Dois pacientes (casos 1 e 2) apresentaram insuficiencia respiratoria aguda. O diagnostico desta complicacao no caso 1 foi clinico pois o paciente apresentou apneia. O paciente do caso 2, 24 horas apos o acidente ofidico apresentou dificuldade respiratoria intensa e periodos de apneia sendo intubado, permanecendo em respiracao espontanea. Houve agravamento dos sinais clinicos de insuficiencia respiratoria e a determinacao de pH e gases do sangue arterial mostrou em relacao ao exame inicial elevacao da pressao parcial de gas carbonico (40 mmHg para 50,3 mmHg) caracterizando insuficiencia ventilatoria aguda. Ambos foram tratados com emprego de ventilacao artificial mecanica, tendo o paciente do caso 1 permanecido no ventilador durante 33 dias e o do caso 2 durante 15 dias. Ambos desenvolveram insuficiencia renal aguda, necessitaram de dialise peritoneal e recuperaram a funcao renal. A paciente do caso 3, apesar dos sintomas e sinais de comprometimento respiratorio...
Subject(s)
Adolescent , Adult , Animals , Humans , Male , Female , Crotalid Venoms/adverse effects , Respiratory Insufficiency/etiology , Acute Disease , Acute Kidney Injury/etiology , Crotoxin/adverse effects , Time FactorsABSTRACT
1. Ninety-eight female rats were injected with 14 microng/g B. jararaca venom intraperitoneally to determine functional and histopathological renal changes. 2. Glomerular filtrataion rate, renal plasma flow, filtration fractional, osmolar clearance, water transportation in collecting ducts, urinary sodium excretion, fractional sodium excretion, albuminuria, urinalysis, plasma creatinine, urinary output and mean arterial pressure were sstudied before and 24 and 48 h after venom administration. Light microscope examination of the kidneys was carried out in another group of rats before and 2,5 and 24h after venom administration. 3. Treated animals developed acute renal failure characterized by a decrease in glomerular filtration rate, osmolar clearance, and fractionalal and urinary sodium excretion, and by an increase in plasma creatinine. There was also a decrease in renal plasma flow and mean arterial pressure. Histopathological examination of the kidneys indicated mild proliferation of the mesangial matrix and degenerative changes of the tubules characterized by loss of brush border and cytoplasmic vacuolation. 4. the hemodynamic changes probably played and important role in the pathogenesis of the functional and histopathological renal changes developed by the animals after venon injection