Snake Bite
Conditions
Keywords
antivenom, snake bite, Bungarus multicinctus, Vietnam
Brief summary
In northern Vietnam, a vast majority of the most severe envenomed patients are bitten by Bungarus multicinctus. Hitherto, these victims have received supportive care only. The aims of this study were to assess the possible efficacy and side effects of a newly produced antivenom.
Detailed description
Venomous snakebites constitute a serious health problem in many Asian countries. In Vietnam, the burden of snakebite on the public health stimulated Calmette to conduct original studies at the Vaccine Institute in Saigon over a hundred years ago and to develop the first snake antivenom ever. In northern Vietnam, a vast majority of the most severe envenomed patients are bitten by Bungarus multicinctus, which is the only krait species giving rise to significant morbidity and mortality in the area. Its venom contains toxins which can cause severe neuromuscular blockade but which do not give rise to swelling or necrosis at the site of the bite. Supportive care is an important part of the management of snakebites, but antivenom administration is the mainstay therapy in the majority of medically significant envenomings. Such specific therapy may dramatically reduce the consequences of the envenomation. In Vietnam, no specific antivenom against B. multicinctus has been available until recently when it has produced for clinical use.
Interventions
Five to ten ampoules of antivenom, depending on severity of muscle paralysis, were diluted with isotonic glucose solution to have total 50 ml and infused intravenously by electric pump during one hour. After a period of 6-8 hours, a second infusion was administered, under similar condition to the first, if no clinical improvement or adverse reaction had been noted. The patients also received supportive care such as intubation, ventilation...if necessary.
Supportive Care only (endotracheal intubation, mechanical ventilation...)
Sponsors
Study design
Eligibility
Inclusion criteria
* Envenomed by B. multicinctus * Showed clinical signs of systemic envenomation (neuromuscular signs) * Provided written informed consent (during the year 2006)
Exclusion criteria
* Pregnancy * Patients had a known history of intolerance to equine serum
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| duration of mechanical ventilation | the length of ICU stay |
Secondary
| Measure | Time frame |
|---|---|
| clinical course during ICU stay | the length of ICU stay |
| complications (Ventilator associated pneumonia...) | the length of ICU stay |
| adverse effects (anaphylaxis, serum sickness...) | the length of ICU stay |
| hyponatremia, renal and liver function | the length of ICU stay |
Countries
Vietnam