RESUMO
To determine the frequency, severity and predictors of bleeding and azotemia after envenomation in humans by Echis coloratus, a retrospective survey of 68 cases in Israel between 1970 and 1989 was carried out. We used univariate and multivariate analyses of clinical variables on admission for the outcome variables of bleeding, hemoglobin and platelet levels, and blood urea. Within hours or days after envenomation, a major bleeding episode occurred in 18% of the victims, a drop in hemoglobin to 10 g/dliter or less in 14%, and an increase in blood urea to 9 mmole/liter or more in 15%. These complications correlated with time interval between envenomation and hospital admission, and the following admission variables: degree of bleeding, hemoglobin level, platelet and white blood cell counts, blood urea and proteinuria. Complications were unlikely in patients who were presented with all of the following: a hemoglobin level of 13 g/dliter or more, a platelet count of 100,000/mm3 or more, a blood urea level of 7 mmole/liter or less, no proteinuria and no bleeding. Treatment on admission with a specific monovalent antiserum was associated with a shorter duration of hemostatic failure and a reduced incidence of anemia and thrombopenia. Infusion of fresh frozen plasma on admission did not appear to be effective in preventing complications.
Assuntos
Anemia/etiologia , Hemorragia/etiologia , Mordeduras de Serpentes/complicações , Uremia/etiologia , Adulto , Fatores Etários , Anemia/prevenção & controle , Animais , Feminino , Seguimentos , Hemoglobinas/análise , Hemorragia/prevenção & controle , Humanos , Imunização Passiva , Israel/epidemiologia , Contagem de Leucócitos , Masculino , Plasma , Contagem de Plaquetas , Probabilidade , Estudos Retrospectivos , Fatores de Risco , Mordeduras de Serpentes/sangue , Mordeduras de Serpentes/epidemiologia , Mordeduras de Serpentes/terapia , Uremia/prevenção & controleRESUMO
A retrospective study of 42 patients bitten by Echis colorata in the last 26 years is reported. Twenty-eight patients received and 14 patients did not receive specific antivenin. The clinical findings, laboratory studies, and course of hospitalization revealed hemostatic disturbances in most of the patients. One of the untreated patients died in the period when antivenin was not available. We recommend that antivenin be given, following appropriate clinical and laboratory assessment, to patients bitten by E. colorata who have progressive local signs and major alterations in the clotting mechanism. The usual precautions against allergic reactions should be taken.
