Bush S P, Jansen P W
Department of Emergency Medicine, Loma Linda University Medical Center, California, USA.
Ann Emerg Med. 1995 Jun;25(6):845-8. doi: 10.1016/s0196-0644(95)70218-0.
A 7-year-old boy presented to the emergency department with severe hypotension and lethargy after a rattlesnake bite. He developed anaphylaxis to antivenom and required intubation, epinephrine, antihistamines, and steroids. Severe rhabdomyolysis and myoglobinuric kidney failure developed over 24 hours, with a peak creatine phosphokinase level of 214,500 units/L. Severe hypocalcemic tetany was treated with replacement therapy. Local wound swelling was never severe and the patient had no coagulopathies. Marked motor weakness improved with antivenom administration. Because of the myotoxic and neurologic effects in the absence of fibrinogenolysis/thrombocytopenia and minimal tissue signs, as well as the similarity to a previously reported case from our area, the envenomation was most likely caused by a Mojave rattlesnake.
一名7岁男孩在被响尾蛇咬伤后，因严重低血压和嗜睡被送往急诊科。他对抗蛇毒血清发生过敏反应，需要插管、使用肾上腺素、抗组胺药和类固醇。在24小时内出现了严重的横纹肌溶解和肌红蛋白尿性肾衰竭，肌酸磷酸激酶峰值水平达到214,500单位/升。严重的低钙性手足搐搦通过替代疗法进行治疗。局部伤口肿胀从未严重，患者也没有凝血功能障碍。给予抗蛇毒血清后，明显的运动无力症状有所改善。由于在没有纤维蛋白溶解/血小板减少和最小组织体征的情况下出现了肌毒性和神经学效应，以及与我们地区先前报告的病例相似，此次蛇咬伤很可能是由莫哈韦响尾蛇造成的。
