Rijal Prabhat, Singh Ajay Pal, Panwar Parshika, Pathania Monika, Kant Ravi
Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
J Family Med Prim Care. 2022 Nov;11(11):7448-7451. doi: 10.4103/jfmpc.jfmpc_1126_22. Epub 2022 Dec 16.
Envenoming and deaths resulting from snake bite are a particularly important public health problem in the tropical world, with the highest burden in rural areas of South East Asia and Africa. Snake bite is one of the most severe "Neglected Tropical Diseases" in the world and more importantly in this part of India. We present a case of hemotoxic snake bite where the coagulation parameters remained deranged for a longer time without any active bleeding manifestations, despite treatment with Anti-Snake Venom (ASV) as per the National Treatment Guidelines. Indian Snake Bite Management Protocol emphasizes on the Role of Whole Blood Clotting Time (WBCT) as a bedside, accessible and feasible test for assessment of coagulopathy even in rural settings. Certain scenarios where the patients present late to our hospital with Snake Bite and Venom Induced Consumption Coagulopathy (VICC), the decision regarding ASV prescription in such patients is quite tricky, and needs to be individualized.
蛇咬伤导致的中毒和死亡是热带地区一个尤为重要的公共卫生问题，在东南亚和非洲农村地区负担最重。蛇咬伤是世界上最严重的“被忽视的热带病”之一，在印度的这一地区更为严重。我们报告一例血液毒性蛇咬伤病例，尽管按照国家治疗指南使用了抗蛇毒血清（ASV）进行治疗，但凝血参数在较长时间内仍紊乱，且无任何活动性出血表现。印度蛇咬伤管理方案强调全血凝固时间（WBCT）作为一种床边可及且可行的检测方法在评估凝血病中的作用，即使在农村地区也是如此。在某些情况下，患者因蛇咬伤和毒液诱导的消耗性凝血病（VICC）而延迟到我院就诊，在此类患者中关于ASV处方的决策非常棘手，需要个体化。
