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Taiwan cobra envenoming: serum venom concentration before and after specific treatment and relationship with debridement of necrotic wound tissue.
Wang, Chia-Cheng; Yang, Chun-Hsiang Ou; Hsu, Chih-Po; Liu, Chien-Chun; Yu, Jau-Song; Lo, Chih-Hong; Fann, Wen-Chih; Chen, Yen-Chia; Lin, Chih Chuan.
Afiliação
  • Wang CC; Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
  • Yang CO; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
  • Hsu CP; Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
  • Liu CC; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
  • Yu JS; Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
  • Lo CH; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
  • Fann WC; Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.
  • Chen YC; Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.
  • Lin CC; Department of Cell and Molecular Biology, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Article em En | MEDLINE | ID: mdl-36721427
Background: Bivalent freeze-dried neurotoxic (FN) antivenom has been the primary treatment since the 1980s for Taiwan cobra (Naja atra) envenomation in Taiwan. However, envenomation-related wound necrosis is a significant problem after cobra snakebites. In the present study, we analyzed the changes in serum venom concentration before and after antivenom administration to discover their clinical implications and the surgical treatment options for wound necrosis. Methods: The patients were divided into limb swelling and wound necrosis groups. The clinical outcome was that swelling started to subside 12 hours after antivenom treatment in the first group. Serum venom concentrations before and after using antivenoms were measured to assess the antivenom's ability to neutralize the circulating cobra venom. The venom levels in wound wet dressing gauzes, blister fluids, and debrided tissues were also investigated to determine their clinical significance. We also observed the evolutional changes of wound necrosis and chose a better wound debridement timing. Results: We prospectively enrolled 15 Taiwan cobra snakebite patients. Males accounted for most of this study population (n = 11, 73%). The wound necrosis group received more antivenom doses than the limb swelling group (4; IQR:2-6 vs 1; IQR:1-2, p = 0.05), and less records of serum venom concentrations changed before/after antivenom use (p = 0.0079). The necrotic wound site may release venom into circulation and cause more severe envenomation symptoms. Antivenom can efficiently diminish limb swelling in cobra bite patients. However, antivenom cannot reduce wound necrosis. Patients with early debridement of wound necrosis had a better limb outcome, while late or without debridement may have long-term hospital stay and distal limb morbidity. Conclusions: Antivenom can efficiently eliminate the circulating cobra venom in limb swelling patients without wound necrosis. Early debridement of the bite site wound and wet dressing management are suggestions for preventing extended tissue necrosis and hospital stay.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: J Venom Anim Toxins Incl Trop Dis Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Taiwan País de publicação: Brasil

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: J Venom Anim Toxins Incl Trop Dis Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Taiwan País de publicação: Brasil