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ACCIDENTS CAUSED BY ACCIDENTS CAUSED BY CROTALUS SNAKESCROTALUS SNAKES
ACCIDENTS CAUSED BY ACCIDENTS CAUSED BY CROTALUS SNAKESCROTALUS SNAKES
- Symposium -Clinical Toxinology and Envenoming
BENEDITO BARRAVIERAProfessor Titular de Infectologia da UNESP
Pesquisador do [email protected]
BENEDITO BARRAVIERAProfessor Titular de Infectologia da UNESP
Pesquisador do [email protected]
Crotalus genus (6 sub-species)
Crotalus durissus terrificus, collilineatus, cascavella, ruruima, marajoensis, trigonicus.
Crotalus durissus terrificus Caudisona durissa terrifica
Crotalus durissus terrificus,
collilineatus,
cascavella,
ruruima,
marajoensis,
trigonicus.
Distribution in Brazil
EPIDEMIOLOGYEPIDEMIOLOGY
GENUS OF SNAKEGENUS OF SNAKEBothropsBothrops – 86,16% – 86,16%CrotalusCrotalus – 8,94% – 8,94%LachesisLachesis – 2,39% – 2,39%MicrurusMicrurus – 0,63% – 0,63%Others – 1,88%Others – 1,88%
SITE OF THE BITESITE OF THE BITELegs – 62,75%Legs – 62,75%Arms – 12, 15%Arms – 12, 15%Others – 25,1%Others – 25,1%
MONTHS OF OCCURRENCEMONTHS OF OCCURRENCEDecember to May - summerDecember to May - summer
SEX, AGE AND PROFESSIONSEX, AGE AND PROFESSIONMale – 76,84%Male – 76,84%Female – 23,16Female – 23,16Age – 15 to 49 years (64,0%)Age – 15 to 49 years (64,0%)Rural workerRural worker
EPIDEMIOLOGYEPIDEMIOLOGY
Guia de Vigilância Epidemiológica, Caderno 14, 24p. 2008.
CENTER FOR THE STUDY OF VENOMS AND VENOMOUS ANIMALS CEVAP- UNESP
Objectives: Promote education, research and extension education in the context of Toxinology (science of toxins from microorganisms, plants and animals).
EPIDEMIOLOGYEPIDEMIOLOGY
Venomous snakes donated to CEVAP between 2002 and 2009
1-Neurotoxic activity neurotoxic symptoms
Crotalic envenoming Clinical aspects
MidriasisLocal bite
Ptosis, Diplopia and blurred vision
Crotalus durissus terrificus
NEUROTOXICITYNEUROTOXICITY
Crotalus durissus terrificusCrotalus durissus terrificus Crotalus durissus terrificusCrotalus durissus terrificus
Crotalic envenoming Clinical aspects
Rhabdomyolysis
Increase of CPK, DHL, AST and ALT
enzymes
Myoglobinuria
2-Systemic rhabdomyolyses skeletal muscle
Crotalus durissus terrificus
RhabdomyolysisCrotalus durissus terrificusCrotalus durissus terrificus
Crotalic envenoming Clinical aspects
Crotalus durissus terrificusEpistaxes
3-Bleeding and Clotting disturbance
Gingival bleeding
Crotalic envenoming Clinical aspects
Tubular necrosis causing renal failure
4-Renal failure
Crotalus durissus terrificus
Crotalic envenoming Clinical aspects
Liver cells with mitochondrial edemaIncrease of Alanine aminotransferase enzyme Liver necrosis
5-Liver toxicity
Liver with edema
Crotalus durissus terrificus
“Acute envenoming syndrome”
SPECIFIC ANTIVENOM CROTALUS TREATMENT
-Mild accident - 10 (100 mg) anticrotalic venom ampules by intravenous route without allergic test;
-Moderate accident - 20 (200 mg) anticrotalic venom ampules by intravenous route without allergic test;
-Severe accident - 30 (300 mg) anticrotalic venom ampules by intravenous route without allergic test.
1-Hospitalize the patient for at least 24 hours;
2-Make Clotting Test after 12 hours to evaluate clotting disturbance and indicate, if necessary, more antivenom;
3-Clean and wash the bite region;
4-Hidrate to prevent renal failure with Manitol 20%, four times a day for at least 5 days.
5-Increase pH with Sodium bicarbonate 5% , 50 ml by oral route, four times a day.
5-Give antibiotic prophylaxis – cefuroxime 125 to 250 mg twice a day, for 5 to 7 days;
6-Indicate tetanus immunoprophylaxis; immunoprophylaxis;
7-If renal failure occurs hemodyalisis.7-If renal failure occurs hemodyalisis.
SUPPORTIVE TREATMENT
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Site:www.jvat.org.br/barraviera/index.htm
Email:[email protected]
Site:www.jvat.org.br/barraviera/index.htm
Email:[email protected]
Pela atenção, Pela atenção, Muito obrigado !!!Muito obrigado !!!Pela atenção, Pela atenção, Muito obrigado !!!Muito obrigado !!!