Karunarathne S, Udayakumara Y, Govindapala D, Fernando H
Department of Clinical Medicine, National Hospital, Colombo, Sri Lanka.
Indian J Nephrol. 2013 Jul;23(4):294-6. doi: 10.4103/0971-4065.114476.
Hump-nosed viper bite can cause acute kidney injury (AKI) and disseminated intravascular coagulation. In some patients, it can cause chronic kidney disease necessitating life-long renal replacement therapy. Lack of effective antivenom makes the management of these patients difficult. A 51-year-old Sri Lankan male was admitted with AKI and disseminated intravascular coagulation following a hump-nosed viper bite. He made a complete recovery with blood product support and hemodialysis. Renal biopsy was performed as his renal recovery was prolonged which revealed patchy tubular atrophy and interstitial inflammation suggestive of subacute interstitial nephritis. Later, he presented with hyperkalemic paralysis and acidosis. A diagnosis of late onset type 4 renal tubular acidosis was made and he responded well to a course of fludrocortisone.
尖吻蝮蛇咬伤可导致急性肾损伤（AKI）和弥散性血管内凝血。在一些患者中，它可导致慢性肾病，需要终身肾脏替代治疗。缺乏有效的抗蛇毒血清使得这些患者的治疗变得困难。一名51岁的斯里兰卡男性在被尖吻蝮蛇咬伤后因急性肾损伤和弥散性血管内凝血入院。在血液制品支持和血液透析下，他完全康复。由于他的肾脏恢复时间延长，进行了肾活检，结果显示有散在的肾小管萎缩和间质炎症，提示为亚急性间质性肾炎。后来，他出现了高钾性麻痹和酸中毒。诊断为迟发性4型肾小管酸中毒，他对氟氢可的松疗程反应良好。
