Kularatne S A M, Hettiarachchi R, Dalpathadu J, Mendis A S V, Appuhamy P D S A N, Zoysa H D J, Maduwage K, Weerasinghe V S, de Silva A
Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Central, Sri Lanka.
General Hospital, Negombo, Sri Lanka.
Toxicon. 2014 Jan;77:78-86. doi: 10.1016/j.toxicon.2013.10.031. Epub 2013 Nov 12.
Sea snakes are highly venomous and inhabit tropical waters of the Indian and Pacific Oceans. Enhydrina schistosa is a common species of sea snake that lives in the coastal waters, lagoons, river mouths and estuaries from the Persian Gulf through Sri Lanka and to Southeast Asia. It is considered one of the most aggressive sea snakes in Sri Lanka where fishermen and people wading are at high risk. However, sea snake bites are rarely reported. In this report, we describe three cases where E. schistosa was the offending species. These three patients presented to two hospitals on the west coast of Sri Lanka within the course of 14 months from November 2011 with different degrees of severity of envenoming. The first patient was a 26-year-old fisherman who developed severe myalgia with very high creatine kinase (CK) levels lasting longer than 7 days. The second patient was a 32-year-old fisherman who developed gross myoglobinuria, high CK levels and hyperkalaemia. Both patients recovered and their electromyographic recordings showed myopathic features. The nerve conduction and neuromuscular transmission studies were normal in both patients suggesting primary myotoxic envenoming. The third patient was a 41-year-old man who trod on a sea snake in a river mouth and developed severe myalgia seven hours later. He had severe rhabdomyolysis and died three days later due to cardiovascular collapse. In conclusion, we confirm that E. schistosa is a deadly sea snake and its bite causes severe rhabdomyolysis.
海蛇毒性极强，栖息于印度洋和太平洋的热带水域。裂颏海蛇是一种常见的海蛇，生活在从波斯湾经斯里兰卡至东南亚的沿海水域、泻湖、河口和港湾。在斯里兰卡，它被认为是最具攻击性的海蛇之一，渔民和涉水者面临的风险很高。然而，海蛇咬伤的报告却很少。在本报告中，我们描述了三例由裂颏海蛇导致咬伤的病例。这三名患者在2011年11月起的14个月内，因不同程度的中毒症状，前往斯里兰卡西海岸的两家医院就诊。第一名患者是一名26岁的渔民，出现严重肌痛，肌酸激酶（CK）水平极高，且持续超过7天。第二名患者是一名32岁的渔民，出现大量肌红蛋白尿、高CK水平和高钾血症。两名患者均康复，其肌电图记录显示为肌病特征。两名患者的神经传导和神经肌肉传递研究均正常，提示为原发性肌毒性中毒。第三名患者是一名41岁男性，在河口踩到一条海蛇，7小时后出现严重肌痛。他患有严重的横纹肌溶解症，三天后因心血管衰竭死亡。总之，我们证实裂颏海蛇是一种致命的海蛇，其咬伤会导致严重的横纹肌溶解症。
