Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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Rhabdomyolysis induced by venomous snake bite

독사 교상 후 발생하는 횡문근 융해증

  • Jungho Lee (Department of Emergency Medicine, Chonnam National University Hospital) ;
  • Jeongmi Moon (Department of Emergency Medicine, Chonnam National University Hwasun Hospital) ;
  • Byeongjo Chun (Department of Emergency Medicine, Chonnam National University Hospital)
  • 이정호 (전남대학교병원 응급의학과) ;
  • 문정미 (화순전남대학교병원 응급의학과) ;
  • 전병조 (전남대학교병원 응급의학과)
  • Received : 2022.08.02
  • Accepted : 2022.10.07
  • Published : 2022.12.31
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Abstract

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.

Keywords

Acknowledgement

재정적 지원: 이 성과는 정부(과학기술정보통신부)의 재원으로 한국연구재단의 지원을 받아 수행된 연구임 (NRF-2022R1A2C2013209) 이 논문은 대한임상독성학회지와 다른 학회지에 동시에 투고되지 않았으며 이전에 다른 학회지에 게재된 적이 없습니다.

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