Jorge M T, Sano-Martins I S, Tomy S C, Castro S C, Ferrari R A, Ribeiro L A, Warrell D A
Hospital Vital Brazil, São Paulo, Brazil.
Toxicon. 1997 Apr;35(4):545-54. doi: 10.1016/s0041-0101(96)00142-0.
The bushmaster (Lachesis muta) of Central and South America, the world's longest pit viper, is capable of injecting a large dose of potent venom when it bites. A 28-year-old man, bitten by a 1.82 m long L. m. muta in Brazil, developed pain and oedema at the bite site, nausea, vomiting, diarrhoea and sweating. There was peripheral neutrophil leucocytosis and evidence of fibrinogen consumption with secondary activation of the fibrinolytic system. Two hours after the bite, eight ampoules of Instituto Butantan Lachesis antivenom was administered, and haemostasis was normal 24 hr later. A review of reports of 20 cases of bites in humans reliably attributed to this snake in Costa Rica, French Guiana, Brazil, Colombia and Venezuela confirms a syndrome of nausea, vomiting, abdominal colic, diarrhoea, sweating, hypotension, bradycardia and shock, possibly autopharmacological or autonomic in origin, not seen in victims of other American crotaline snakes. These, and other symptoms of bushmaster envenoming, are explained by haemorrhagic, coagulant and neurotoxic venom activities. The therapeutic efficacy of non-specific Bothrops/Crotalus polyvalent antivenoms in these cases has been unimpressive. For the treatment of bites by a snake which potentially injects a large dose (> 300 mg dry weight) of venom with a range of life-threatening activities, there is an urgent need to develop more potent specific antivenoms and to treat the dramatic and life-threatening cardiovascular symptoms.
中美洲和南美洲的巨蝮（Lachesis muta）是世界上最长的蝰蛇科毒蛇，咬人时能够注入大量强效毒液。一名28岁男子在巴西被一条1.82米长的巨蝮咬伤后，咬伤部位出现疼痛和水肿，伴有恶心、呕吐、腹泻和出汗症状。外周血中性粒细胞增多，并有纤维蛋白原消耗及纤溶系统继发性激活的证据。咬伤两小时后，注射了8支布坦坦研究所生产的抗巨蝮蛇毒血清，24小时后止血功能恢复正常。对哥斯达黎加、法属圭亚那、巴西、哥伦比亚和委内瑞拉20例确认为被这种蛇咬伤的人类病例报告进行回顾，证实了一种综合征，包括恶心、呕吐、腹部绞痛、腹泻、出汗、低血压、心动过缓和休克，可能源于自身药理作用或自主神经功能紊乱，这在其他美洲响尾蛇咬伤的受害者中未见。这些以及巨蝮蛇咬伤的其他症状可由出血性、凝血性和神经毒性毒液活性来解释。在这些病例中，非特异性的矛头蝮属/响尾蛇属多价抗蛇毒血清的治疗效果并不理想。对于被可能注入大量（>300毫克干重）具有一系列危及生命活性毒液的蛇咬伤的治疗，迫切需要研发更有效的特异性抗蛇毒血清，并治疗严重且危及生命的心血管症状。
