Department of Surgery, Khayelitsha District Hospital, Stellenbosch University, Western Cape, South Africa.
Department of Surgery, Tygerberg Hospital, Stellenbosch University, Western Cape, South Africa.
Toxicon. 2021 Jan 30;190:73-78. doi: 10.1016/j.toxicon.2020.12.009. Epub 2020 Dec 17.
Cytotoxic snakebite envenomation is prevalent in Kwazulu-Natal and may be associated with significant physical disability. The aim of this study was to provide an overview of the effects of cytotoxic envenomation in children. The patient population were all patients attending the Emergency Department at Ngwelezana Tertiary Hospital with snakebite from December 2014 to March 2015. All children 13 years or younger presenting with painful progressive swelling (PPS) following snakebite were included in this study. They were further classified according to severity: mild, moderate and severe. Patient demographic and clinical data was collected prospectively. Fifty-one children were included in this study. Nine were classified as mild, 24 as moderate and 18 as severe. The median time of presentation after bite was 6 h in the mild group, 7 h in the moderate group and 12 h in the severe group. There was a positive correlation between increasing severity and INR (p=< .00001) and no correlation between WCC (p = .175) or renal function and severity (p = .963). A total of 11 children (22%) developed an acute kidney injury (AKI). A total of 23/51 patients received antivenom; 25% of patients with moderate cytotoxicity and 94% of patients with severe cytotoxicity. Thirteen percent developed allergic reactions (3/23) and 57% (13/23) anaphylaxis. A total of 15 patients underwent one or more procedures on their affected limbs. There was one recorded mortality during this period, related to severe anaphylaxis following antivenom administration. Access to healthcare for antivenom administration is often delayed and ongoing education within affected areas is advised. Whilst majority of snakebite victims can be adequately managed with basic supportive measures, early identification of severe envenomation is crucial to enable timeous antivenom administration and prevention of further complications such as compartment syndrome and loss of limb. Hypersensitivity reactions are alarmingly common following antivenom administration in children and strict protocols should be followed when administering antivenom.
细胞毒素性蛇伤中毒在夸祖鲁-纳塔尔很常见，可能导致严重的身体残疾。本研究旨在概述细胞毒素性蛇伤中毒对儿童的影响。患者人群均为 2014 年 12 月至 2015 年 3 月期间在恩格韦莱扎纳三级医院因蛇伤就诊的急诊科患者。所有 13 岁以下儿童在蛇伤后出现疼痛性进行性肿胀（PPS）者均纳入本研究。根据严重程度进一步分类：轻度、中度和重度。前瞻性收集患者的人口统计学和临床数据。本研究共纳入 51 例患儿。轻度组 9 例，中度组 24 例，重度组 18 例。轻度组咬伤后中位就诊时间为 6 小时，中度组为 7 小时，重度组为 12 小时。严重程度与 INR 呈正相关（p<.00001），与 WCC 无相关性（p=.175）或肾功能与严重程度无相关性（p=.963）。共有 11 例儿童（22%）发生急性肾损伤（AKI）。共有 23/51 例患者接受抗蛇毒血清治疗；中度细胞毒性患者中 25%，重度细胞毒性患者中 94%。有 13%发生过敏反应（3/23），57%（13/23）发生过敏反应。共有 15 例患者在受影响的四肢上进行了一次或多次手术。在此期间，有 1 例死亡，与抗蛇毒血清治疗后严重过敏反应有关。获得抗蛇毒血清治疗的医疗服务往往会延迟，建议在受影响地区持续开展教育。虽然大多数蛇伤患者可以通过基本的支持措施得到充分治疗，但早期识别严重的蛇伤中毒对于及时给予抗蛇毒血清治疗和预防筋膜间室综合征和肢体丧失等进一步并发症至关重要。儿童接受抗蛇毒血清治疗后，过敏反应非常常见，应严格遵循治疗方案。
