Study

China
Sawai et al. 1992: description of 64 Deinagkistrodon acutus bites. Identification: snakes not clearly identified or evidence for identification lacking.

Case reports

Taiwan

Kuo and Wu 1972: 4 cases, 3 of which are described in detail; no information regarding the basis on which species identification was made.

Signs & symptoms

Autopharmacological effects

Nausea, vomiting, abdominal pain 2/4 (Kuo and Wu 1972).

Local effects

Local pain and swelling (extensive) 4/4, blister formation (blood-tinged contents) 2/3 (Kuo and Wu 1972).

Necrosis (Kuo and Wu 1972).

Local swelling 61/64, local necrosis 13/64 (Sawai et al. 1992).

Haemostatic effects

Gastrointestinal bleeding, including gingival bleeding and epistaxis 2/4 (Kuo and Wu 1972).

Morbidity

Necroses 4/4, some with extensive loss of soft tissue and impairment of function. One patient had a gangrenous finger amputated (Kuo and Wu 1972).

Case fatality rate

0/4 (Kuo and Wu 1972).
3/64; interval between the bite and death: 15–49 h (Sawai et al. 1992).

Laboratory and physical investigations

1. Haemostasis
Type of haemostatic defect

Direct fibrinogen-coagulating ("thrombin-like") activity (acutin) and reactive (secondary) fibrinolysis (Stocker 1990).

 

Haemostatic parameters

Overview haemostasis

A

H

CT

(FSP)

Tc

PT

aPTT

TT

I

FSP

D

II

V

VIII

X

XIII

PC

ATIII

PI

tPA

α2AP

B

Essential bed-side tests

Tests for full clinical assessment

Tests for research purposes

H haemorhagic effects + definite evidence in human envenoming CT full blood clotting test (FSP)  FSP rapid test Tc platlets PT prothrombin time aPTT partial thromboplastin time TT thrombin time I fibrinogen FSP  fibrinogen split products D D-dimer II, V, VII, X, XIII   clotting factors PC protein C ATIII antithrombin III PI plasminogen tPA tissue plasmin activator α2AP α2-antiplasmin   In this overview, the deviations from normal are recorded for those haemostasis para- meters only, for which good evidence is documented in the literature.

 

A	Clotting time: blood incoagulable for 3.5 days (no antivenom administration) (Kuo and Wu 1972).
B	Fibrinogen: 30 mg% for 8 days (no antivenom administration) (Kuo and Wu 1972).

2. Leucocytes
Leucocytosis 4/4 (Kuo and Wu 1972).

3. Haemoglobin
Anaemia 2/4; minimum 5.5 mg/100 ml (Kuo and Wu 1972).

Treatment (symptomatic)

Blood transfusions (Kuo and Wu 1972).

Treatment (specific)

Antivenoms
Taiwan: Agkistrodon, National Institute of Preventive Medicine, Taipei, Taiwan.
China: Monovalent, Shanghai Institute of Biological Products, Shanghai, China.

Efficacy
Taiwan:

With regard to the haemostatic defect:

• clinical: in 2 patients bleeding ceased simultaneously with antivenom administration (Kuo and Wu 1972),
• coagulation defect (laboratory investigations): in 2 patients haemostatic tests returned to normal simultaneously with antivenom administration (Kuo and Wu 1972).

China: 29 patients received antivenom, 11 of them had severe envenoming, none died. All 3 patients who died (from 64 cases) had not received antivenom (Sawai et al. 1992).

Dose
Taiwan: 20–40 ml (Kuo and Wu 1972).
China: 1–4 vials (8,000 U/vial) (Sawai et al. 1992).