Journal of The Korean Society of Clinical Toxicology

Rhabdomyolysis induced by venomous snake bite: Lee Jungho, Moon Jeongmi, Chun Byeongjo; J Korean Soc Clin Toxicol. 2022;20(2):51-57. Published online December 31, 2022; DOI: https://doi.org/10.22537/jksct.2022.20.2.51

982 View
30 Download

Abstract PDF: Purpose: Despite previous studies reporting the development of rhabdomyolysis (RM), this affliction tends to be neglected as an envenomation sign in South Korea. The current retrospective study investigates the prevalence and prognosis of RM after a snakebite. We further searched for predictors of snakebite-induced RM, which can be observed at presentation. Methods: This study included 231 patients who presented to the ED within 24 hours after a snakebite. The patients were classified according to the severity of RM, and the data, comprising baseline characteristics and clinical course including the level of creatine kinase (CK), were collected and compared according to the severity of RM. Results: The prevalence of RM and severe RM were determined to be 39% and 18.5%, respectively. Compared to the group without RM or with mild RM, the group with severe RM had a higher grade of local swelling, a higher frequency of acute kidney injury and neurotoxicity, and a greater need for renal replacement therapy and vasopressor administration. However, the incidence of acute renal injury in the RM group was 7.7%, with two patients needing renal replacement therapy. No mortalities were reported at discharge. Results of the multinomial logistic regression model revealed that the WBC levels are significantly associated with the risk of severe RM. Conclusion: RM should be considered the primary clinical sign of snake envenomation in South Korea, although it does not seem to worsen the clinical course. In particular, physicians should pay attention to patients who present with leukocytosis after a snakebite, which indicates the risk of developing RM, regardless of the CK level at presentation.

Epidemiology of patients with snake bite or envenomation in emergency department: NEDIS (National Emergency Department Information System): Lee Serok, Jeon Woochan; J Korean Soc Clin Toxicol. 2022;20(2):45-50. Published online December 31, 2022; DOI: https://doi.org/10.22537/jksct.2022.20.2.45

1,105 View
46 Download
1 Citations

Purpose: This study utilizes the NEDIS (National Emergency Department Information System) database to suggest a predictive model for snakebite and envenomation in Korea by analyzing the geographical distribution and seasonal variation of snakebite patients visiting the ER. Methods: This was a retrospective study on snakebite patients visiting the ER using the NEDIS database from January 2014 to December 2019. The subjects include patients with the KCD (Korea Standard Classification of Disease) disease code T63.0 (Toxic effect of contact with snake venom). Geographical location, patient gender, patient age, date of ER visit, treatment during the ER stay, and disposition were recorded to analyze the geographical distribution and seasonal variation of snakebite patients in Korea. Results: A total of 12,521 patients were evaluated in this study (7,170 males, 54.9%; 5,351 females, 40.9%). The average age was 58.5±17.5 years. In all, 7,644 patients were admitted with an average admission time of 5.04±4.7 days, and 2 patients expired while admitted. The geographical distribution was Gyeongsang 3,370 (26.9%), Cheonra 2,692 (21.5%), Chungcheong 2,667 (21.3%), Seoul Capital area 1,999 (16.0%), Kangwon 1,457 (11.6%), and Jeju 336 (2.7%). The seasonal variation showed insignificant incidences in winter and higher severity in spring and summer than in fall: winter 27 (0.2%), spring 2,268 (18.1%), summer 6,847 (54.7%), and fall 3,380 (27.0%). Conclusion: Patients presenting with snakebites and envenomation in the emergency room were most common in the Gyeongsang area and during summer. The simple seasonal model predicted that 436 snakebites and 438 envenomation cases occurred in July and August. The results of this study can be applied to suitably distribute and stock antivenom. Appropriate policies can be formed to care for snakebite patients in Korea.

Citations

Citations to this article as recorded by

Comprehensive molecular characterization and comparison of venom proteins and transcripts in three Gloydius species from South Korea
Hyo Sun Park, Jeong Mi Moon, Byeong Jo Chun, Yerin Min, Yong Soo Cho, Kwang-Hyun Park, Sujin Lee, Yeonjong Koo
Scientific Reports.2026;[Epub] CrossRef

A Case Report of Envenomation and Injury by a Poisonous Spine of A Marble Motoro (Potamotrygon Motoro): Min Hong Choa, Seung Ho Jun, Duk Hwan Kim, Jong Su Park, Su Jin Kim, Yun Sik Hong, Sung Woo Lee; J Korean Soc Clin Toxicol. 2013;11(1):46-48. Published online June 30, 2013

458 View
2 Download

Abstract PDF: Potamotrygon motoro, also known as the Marble motoro, is a potamodromous freshwater ray native to the basins of the Amazon River. Marble motoros were introduced to South Korea in the 2000s, and, because they are easy to raise, were sold as aquarium fish. The aim of this report is to illustrate a new case involving envenomation by a Marble motoro. A 35-year-old commercial aquarium assistant came to the hospital after being pricked by a Marble motoro. The clinical picture in this case showed acute local pain with minimal systemic manifestations. This patient recovered after receiving symptomatic treatment and wound care. This case of envenomation accentuates the potential for injury among people coming in contact with a venomous Marble motoro.

Multicenter Survey of Intoxication Cases in Korean Emergency Departments: 2nd Annual Report, 2009: Ae-Jin Sung, Kyung-Woo Lee, Byung-Hak So, Mi-Jin Lee, Hyun Kim, Kyung-Hye Park, Jeong-Bae Park, Seok-Ran Yeom, Seong-Beom Oh, Ji-Young You, Kyung-Won Lee, Byeong-Jo Chun, Young-Joon Kang; J Korean Soc Clin Toxicol. 2012;10(1):22-32. Published online June 30, 2012

499 View
3 Download

Abstract PDF: Purpose: The purpose of this study was to examine the occurrence of toxic exposure cases in Korean emergency centers using a toxic exposure surveillance system-based report form and to provide guidelines for the prevention and treatment of toxic exposures. Methods: We retrospectively reviewed the medical records of toxic exposure patients who had visited emergency centers from January 2009 to December 2009. Epidemiology data points for the toxic exposure cases included age, gender, type of exposure, number and kind of substances involved, reason and route of poison exposure, management of the patients in the emergency departments, and the clinical outcome. Results: A total of 3,501 patients from 12 emergency departments were enrolled in the study. 50.0% of the total exposure patients were male and 63.0% of the total cases were fatal. Acute intoxication occurred in 91.3% of the total patients and suicidal intent was the most common (43.3%) reason for exposure. The most common route of exposure was ingestion (75.9%). Of the total cases, pesticides were involved in 26.3%, sedatives/hypnotics/antipsychotics were involved in 22.0%, and bites and envenomations were involved in 15.7%. Conclusion: We provided a database of patients who were admitted to emergency departments after poisoning incidents. We recommend that toxicology professionals develop a classification scheme for toxicants which is adequate for Korean domestic circumstances and initiate a toxic surveillance system for all types of exposures. With support of a psychiatric surveillance system for suicidal patients and establishment of social mediation for pesticide poisoning, major reductions in poison exposures can be achieved.

Two Cases of Disseminated Intravascular Coagulation (DIC) Following Pit Viper Envenomation: Suk-Hwan Kim, Se-Min Choi, Young-Min Oh, Kyu-Nam Park, Won-Jae Lee, Kyung-Ho Choi; J Korean Soc Clin Toxicol. 2006;4(2):137-142. Published online December 31, 2006

540 View
2 Download

Abstract PDF: Our records include two cases of DIC in snakebite patients. One patient, who was 48-years old, was bitten in his left ankle 3 days before admission to our hospital. Initial symptoms were painful swelling, extensive ecchymosis, and persistent bleeding at the bite site. He visited and was admitted to a local hospital, but his condition did not improve with supportive care that included a single dose of antivenin. He was transferred to our hospital. His condition was compatible with DIC. We tried multi-dose antivenin therapy and blood product transfusion. At the seventh hospital day, the patient's symptoms were completely resolved. The other patient, who was 75 years old, was bitten in his right thumb. Initial symptoms were painful swelling of the right arm and persistent bleeding at the bite site, and within minutes of hospital admission, the patient experienced massive hematochezia. We peformed laboratory tests, the results of which were compatible with DIC, and the next day a sigmoidscopic examination showed ischemic colitis. We administered multi-dose antivenin therapy and blood product tranfusion. At the third hospital day mild anemia still existed, but the patient's clinical condition was improved. No signs or symptoms of gastrointestinal bleeding were observed. In these two cases, multi-dose antivenin therapy and transfusion effectively resolved symptoms of DIC. Platelet concentrate transfusion was required only for acute thrombocytopenia. After resolution of DIC, platelet counts were returned to normal ranges within a few days. The authors propose that multidose antivenin therapy and coagulation factor transfusion might be useful for improving coagulopathy in snakebite patients.

First
Prev
Page of 1
Next
Last

Search