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Clinic

 

Deinagkistrodon acutus

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).