Pahari Nabin, Sharma Bishnu Dhakal, Ghimire Sagun, Sharma Shanta, Kafle Bikram, Upadhaya Tekraj, Montasir Ahmed Al
Department of Intensive Care, Lumbini Provincial Hospital.
Department of Nephrology, Lumbini Provincial Hospital, Rupandehi, Nepal.
Ann Med Surg (Lond). 2024 Apr 16;86(9):5489-5491. doi: 10.1097/MS9.0000000000002072. eCollection 2024 Sep.
Owing to the high number of envenomation and fatalities, the Russell's viper holds greater medicinal significance than any other Asian serpent. South East Asia is one of the most snakebite-prone regions in the world. Dense population, extensive agricultural practices, the abundance of venomous snake species, and an overall lack of knowledge about primary treatment (first aid) are the major culprits associated with snake bite-related morbidity and mortality. The venom of vipers is known to produce vasculotoxicity and contains hemotoxins.
The authors describe a patient who was bitten by a viperine snake and showed signs of both neurotoxicity and acute kidney injury (AKI). The 20 years male was treated in a tertiary care centre in Nepal. The patient developed respiratory failure and needed ventilator support. Further, more haemodialysis was also done to manage AKI. Later, the patient was discharged after a smooth recovery.
Numerous clinical manifestations, such as neurotoxicity and vasculotoxicity, can result from a viperine bite. The majority of viperine snakebites are hemotoxic. Dual neurotoxic symptoms are possible after a viperine bite despite their rarity. The prevention of respiratory failure depends critically on the early detection of neurotoxicity.
Unusual neuromuscular paralysis is caused by Russell's vipers (Daboia russelii) in South East Asia. Physicians should know the exceptional presentations of snakebites to diagnose and treat patients.
由于被罗素蝰蛇咬伤的人数众多且致死率高，该蛇种比其他任何亚洲蛇类都具有更大的医学意义。东南亚是世界上蛇咬伤发生率最高的地区之一。人口密集、广泛的农业活动、丰富的毒蛇种类以及对初级治疗（急救）普遍缺乏了解，是导致与蛇咬伤相关的发病和死亡的主要原因。蝰蛇的毒液已知会产生血管毒性，且含有溶血毒素。
作者描述了一名被蝰蛇咬伤的患者，该患者表现出神经毒性和急性肾损伤（AKI）的症状。这名20岁男性在尼泊尔的一家三级护理中心接受治疗。患者出现呼吸衰竭，需要呼吸机支持。此外，还进行了更多次血液透析以治疗急性肾损伤。后来，患者顺利康复出院。
蝰蛇咬伤可导致多种临床表现，如神经毒性和血管毒性。大多数蝰蛇咬伤是溶血毒性的。蝰蛇咬伤后出现双重神经毒性症状虽罕见但有可能。预防呼吸衰竭关键取决于对神经毒性的早期检测。
东南亚地区，罗素蝰蛇（Daboia russelii）会导致不寻常的神经肌肉麻痹。医生应了解蛇咬伤的特殊表现，以便诊断和治疗患者。
