Clinical and epidemiologic profile and predictors of outcome of poisonous snake bites - an analysis of 1,500 cases from a tertiary care center in Malabar, North Kerala, India. 2012;6(9):e1841. Intensive Care Unit (ICU); Polyvalent Anti-snake venom (ASV); whole blood clotting test (WBCT); Acute Respiratory Distress Syndrome (ARDS) ; Acute Kidney Injury(AKI); Disseminated Intravascular Coagulation (DIC); Anterior Wall myocardial infarction (AMI); Cerebro-Vascular Accidents (CVA). Johnston CI, O'Leary MA, Brown SG, Currie BJ, Halkidis L, Whitaker R, Close B, Isbister GK; ASP Investigators. 2020 Sep 10;12(9):583. doi: 10.3390/toxins12090583. In conclusion, in this series of snakebite patients, the combination of INR, aPTT and CK level, together with repeated neurological assessments, detected all but two cases of severe envenoming within 12 hours. 2010 Jun;36(4):444-51. doi: 10.1055/s-0030-1254053. In 178 of the 206 patients (86%), the INR was abnormal (> 1.2) on the first set of tests using blood samples taken a median of 1 hour and 36 minutes after the bite (range, 20 min – 11 h 30 min) (Box 3). Ethics approval has been obtained from 19 human research ethics committees covering all institutions involved in the study. This site needs JavaScript to work properly. 2015 Apr;29(2):82-9. doi: 10.1016/j.tmrv.2014.09.005. Molecules. There were 222 patients with severe envenoming who presented within 6 hours of the bite, and 213 of these (96%) had documented abnormal laboratory test results at 6 hours. of publication, Information for librarians and institutions. Laboratory parameters (INR, aPTT and CK) and neurological reassessments identified nearly all severe envenoming cases within 12 hours of the bite, even in this conservative analysis that assumed normal test results if the test was not done.  | From the 27 brown snake bites, 25 had samples available after an initial median dose of four vials of antivenom (IQR 2–5 vials; range 1–10). Of 120 non-envenomed patients who had their CK level measured in the first 6 hours, 18 (15%) had an abnormal CK level. Snake Bite Envenomation in a Tertiary Care Centre. All patients with a suspected snake bite should be managed in a facility with access to antivenom, critical care facilities and a 24-hour laboratory for blood tests. An Appraisal of Antidotes' Effectiveness: Evidence of the Use of Phyto-Antidotes and Biotechnological Advancements. Int J Gen Med. Get the latest research from NIH: Myotoxicity: a creatine kinase (CK) level > 1000 U/L, with myalgia and/or muscle tenderness. Both patients who did not have abnormal test results within 12 hours had myotoxicity and did not have laboratory tests performed at 6 or 12 hours, when it was likely their CK levels would have been elevated. Neurotoxicity: with either two nerve groups (eg, ocular and bulbar) involved, respiratory muscle paralysis, or requirement for intubation or mechanical ventilation. These syndromes are a major source of delayed or missed envenoming, so larger studies of these groups are needed to confirm our approach in such cases. NCI CPTC Antibody Characterization Program. In addition, plots were made and the time to development of each abnormal laboratory test result (INR, aPTT, CK and WCC) or neurological examination was estimated for individual envenoming syndromes (VICC, myotoxicity and neurotoxicity). In seven patients where the time from the bite to the first abnormal INR was greater than 6 hours, this reflected a delay of 4 or more hours between the first (normal) INR and the second (abnormal) INR. CK = creatine kinase. Using a combination of three laboratory tests (INR, aPTT and CK) and repeated neurological examination, 238 of the 240 patients with severe envenoming (99%) had an abnormal laboratory test result or evidence of neurotoxicity by 12 hours (Box 3 and Box 4, B). Coagulation studies were the most useful early laboratory parameters (Box 4, A) because the major clinical syndrome was VICC. There were 20 patients with thrombotic microangiopathy, and all had preceding evidence of VICC, with an abnormal INR within 12 hours. † D-dimer test may need repeating if it is moderately elevated (ie, greater than assay cut-off but less than 10 times the cut-off) because this is more likely to be a false positive. All patients have demographic and clinical information, laboratory test results and treatments recorded on a clinical research form, which is then entered into a purpose-built relational database. BMC Immunol. Med J Aust. 2010 Feb 9;268(3):148-54. doi: 10.1016/j.tox.2009.09.013. Assessing which assays are the most informative in snake envenoming, based on the pathophysiology of snakebite coagulopathy, will optimize diagnosis and timing of appropriate coagulation tests. Design, patients and setting: Prospective cohort study of 478 patients with suspected or confirmed snakebite recruited to the Australian Snakebite Project from January 2002 to April 2009, who had at least three sets of laboratory test results and at least 12 hours of observation in hospital after the bite.  | A similar analysis was done to determine if minor envenoming could be excluded with the same combination of repeat tests and neurological examination. 2005 Jun 15;45(8):951-67. doi: 10.1016/j.toxicon.2005.02.030. Clinical effects of red-bellied black snake (Pseudechis porphyriacus) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP-11). O'Rourke KM, Correlje E, Martin CL, Robertson JD, Isbister GK. Patients recruited to ASP from January 2002 to April 2009 were included in this study if at least three sets of laboratory test results were available and the patient was observed in hospital for at least 12 hours after the bite or was admitted to hospital with envenoming. Suggested Laboratory Tests for Snakebite Patients in Major Hospitals • Snake venom detection (CSL Kit) on bite site (or urine if there is systemic envenoming). WCC = white cell count. NLM Conclusions: Of these 18, the CK level decreased on the next blood test for 13, and on the second subsequent blood test for three. Severe envenoming was defined as venom-induced consumption coagulopathy (VICC), myotoxicity, neurotoxicity or thrombotic microangiopathy. * Some patients had more than one severe envenoming syndrome, making the sum of the individual syndromes greater than the total number of patients with severe envenoming. Of the remaining five, two had an abnormal aPTT within 12 hours; one had myotoxicity with CK > 250 U/L within 12 hours; and two never had an abnormal INR, and identification of their partial VICC was based on a low fibrinogen or high D-dimer level. 2018 Mar;66(3):55-9. Toxicology. Of the 1051 cases, haemotoxic bites outnumbered 586 (56%) neurotoxic ones 435 (41%). HHS Non-envenomed patients were those who did not manifest any of these clinical or laboratory features of minor or severe envenoming during their hospital stay of at least 12 hours and did not re-present to the hospital with delayed envenoming. An abnormal aPTT had occurred in 20 patients (61%) at 6 hours and in 25 patients (76%) at 12 hours. In addition, modification to the assessment pathway proposed in Box 5 may be needed for geographical regions with venomous snake fauna not well represented in our dataset. However, using our suggested approach means that some patients who do not have envenoming will be kept in hospital if they have an abnormal laboratory test result. No Australian study has systematically examined the changes in early laboratory test results observed in envenomed or non-envenomed patients after snakebite. • Urine (ward test=dipstix looking for blood=?myoglobin or ? The cut-off values used to define abnormal results were: INR > 1.2, aPTT outside the reference range (depending on the individual laboratory), CK > 250 U/L, and WCC > 11.0 × 109/L. There is a possibility that some of these patients developed envenoming after discharge. NIH Clipboard, Search History, and several other advanced features are temporarily unavailable. Laboratory diagnosis is a key part of the treatment of snakebite coagulopathy. Results: Nine cases of isolated neurotoxicity had a median time of onset after the bite of 4 hours (range, 35 min – 12 h). As the full effects of toxins on the coagulation pathway are rarely examined, even in vitro, our understanding of the pathophysiology of envenoming is limited. PBI = pressure bandages with immobilisation. Transfus Med Rev. This patient developed myotoxicity with localised myalgia and a CK level peaking at 12 028 U/L at 46 hours after the bite, with ptosis and diplopia but no VICC.