Optimal Dose of Antivenin for Asymptomatic or Minor Envenomation Patient with Korean Viperidae Injuries

PURPOSE: The aim of this study was to evaluate the feasibility and safety of our antivenin treatment protocol for patients with Korean Viperidae envenomation. METHODS: We developed an antivenin treatment protocol for Korean Viperidae envenomation, based on previous data, and applied this treatment to the enrolled patients. In brief, antivenin was not used for patients with grade 0. Patients with grade I and II received one vial of antivenin. Those with grade III and IV received two and three vials of antivenin, respectively. Adult patients who visited the emergency department (ED) after receiving a snakebite between July 2008 to August 2010 were included. Follow ups were performed at 24 hours, 7 days, and 28 days after the snakebite. RESULTS: A total of 62 patients were enrolled. At the initial evaluation, 6 patients (9.7%) were grade 0, 47 patients (75.8%) were grade I, and 9 patients (14.5%) were grade II. Upon the follow-up evaluation, 14 patients (29.8%) progressed from grade I to grade II and 2 patients (22.2%) progressed from grade II to III. Coagulopathy developed in 5 patients (8.0%) and rhabdomyolysis in 5 patients (8.0%). Urticaria developed in 2 patients (3.2%) and cellulitis in 3 patients (4.8%) as delayed complications. As an antivenin-related complication, serum sickness developed in only 1 patient (1.6%). There were no severe complications and all clinical and laboratory abnormalities disappeared within 28 days. CONCLUSION: Our antivenin treatment protocol was feasible and safe. To confirm our data, multicenter validation studies are needed.

Poor Prognosis of Patients with Septic Shock Associated with Low Serum Selenium Levels

PURPOSE: To investigate whether or not low clinical serum selenium levels are associated with survival prognosis for septic shock patients. METHODS: This was a prospective, observational study conducted in an emergency Intensive Care Unit (ICU) at a tertiary referral hospital in Korea. We enrolled consecutive, septic shock patients who were admitted to the ICU from March 2008 to February 2010. We collected patient data with respect to demographics, infection sites, pathogens, serum lactate levels, central venous oxygen saturations, and serum selenium levels at the time of ICU admission. We also collected data with respect to 6-hour early goal achievement, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, mechanical ventilator or renal replacement therapy application, and steroid administration. Using a 28-day mortality criterion, enrolled patients were divided into two groups: survivors and non-survivors. Resulting data was compared between the two groups. RESULTS: Among 115 patients, 81 were the survivors and 34 were non-survivors. Lower serum selenium levels (odds ratio [OR]=0.945, 95% confidence intervals [CI], 0.908-0.984, p=0.006) and higher APACHE II scores (OR=1.096, 95% CI, 1.006-1.195, p=0.036) were independently associated with 28-day patient mortality results. The cutoff serum selenium level was 47.5 microg/L (sensitivity 0.80, specificity 0.71, area under curve=0.745) for 28-day mortality. CONCLUSION: Serum selenium levels of 47.5 microg/L or lower are associated with 28-day mortality for septic shock patients.