Division of Pediatric Emergency Medicine Dana-Dwek Children's Hospital, Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel.
Division of Clinical Toxicology, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
Clin Toxicol (Phila). 2022 Mar;60(3):293-297. doi: 10.1080/15563650.2021.1959604. Epub 2021 Jul 28.
Antivenom has been used successfully to treat systemic and progressive, local manifestations of envenomations inflicted by , the second most common cause of snake envenomation in Israel. There is a paucity of published data regarding the use of monovalent (equine) immunoglobulin G antivenom in children. This study describes outcomes from the regimen used in two large, tertiary care pediatric centers.
A retrospective chart review of children admitted with definite or probable signs of envenomation to Sourasky (Tel Aviv) and Soroka (Be'er Sheva) Medical Centers from January 1st 2008-to June 1st 2019. Extracted data included age, location of bite, time to hospital arrival, laboratory test results, complications, time to antivenom administration if indicated, adverse effects of the antivenom, and outcomes. Indications for antivenom were: diagnosis of as the etiology of envenomation, local and systemic signs e.g. skin puncture wounds, swelling of the involved limb, local hematoma, and abnormal coagulation blood test results.
During the study period, 11 children were treated with intravenous antivenom. Median age was 9 years and 10 of 11 patients were male. Two patients underwent fasciotomy; in one, compartment syndrome was diagnosed by pressure measurement, and in the second, clinically. One patient developed mild urticaria 30 min after initiation of the antivenom; the treatment was stopped and then restarted at a slower rate after he was treated with hydrocortisone and diphenhydramine. No further adverse reactions were observed.
In children, antivenom appeared to be effective and safe for the treatment of systemic and progressive local manifestations of envenomation by .
抗蛇毒血清已成功用于治疗由引起的全身性和进行性局部蛇伤，这是以色列第二常见的蛇伤原因。关于在儿童中使用单价（马）免疫球蛋白 G 抗蛇毒血清的数据很少。本研究描述了在两个大型三级儿科中心使用该方案的结果。
对 2008 年 1 月 1 日至 2019 年 6 月 1 日期间因确诊或疑似被咬伤而入住 Sourasky（特拉维夫）和 Soroka（贝尔谢巴）医疗中心的儿童进行回顾性图表审查。提取的数据包括年龄、咬伤部位、到达医院的时间、实验室检查结果、并发症、如有指征给予抗蛇毒血清的时间、抗蛇毒血清的不良反应以及结果。使用抗蛇毒血清的指征为：诊断为蛇伤病因、局部和全身症状，如皮肤穿刺伤、受累肢体肿胀、局部血肿和异常凝血血液检查结果。
在研究期间，有 11 名儿童接受了静脉注射抗蛇毒血清治疗。中位年龄为 9 岁，11 名患者中有 10 名为男性。2 名患者接受了筋膜切开术；其中 1 例通过压力测量诊断为筋膜间室综合征，另 1 例为临床诊断。1 名患者在开始使用抗蛇毒血清后 30 分钟出现轻度荨麻疹；抗蛇毒血清停止使用，然后在给予氢化可的松和苯海拉明后以较慢的速度重新开始。未观察到其他不良反应。
在儿童中，抗蛇毒血清似乎对治疗由引起的全身性和进行性局部蛇伤是有效且安全的。
