• Journal of The Korean Society of Clinical Toxicology
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• v.7 no.2
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• pp.97-104
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• 2009

Purpose: Antivenin is a standard therapy in snakebite victims. While the required antivenin dose can be easily estimated, based on the initial symptoms, this strategy may be unsuccessful if the initial symptoms progressively worsen. The purpose of this study was to identify the progression rate of the initial symptoms following snakebite and its associated factors. Methods: The medical records of 44 patients treated for snakebite from give the actual dates of the study period were retrospectively examined. Thirty-two of these patients were enrolled. Demographic data, local wound grade and local effect score at initial presentation (G-0 and LES-0, respectively) and 12 hours after admission (G-12 and LES-12, respectively) were reviewed, along with laboratory data. Results: The 32 patients had an average age of $54.0{\pm}14.5$ years and were predominantly male (n=26) and presented mainly during summer. Compared to G-0 and LES-0, re-evaluated G-12 and LES-12 were significantly increased despite initial administration of proper antivenin dosage (p=0.001 and p=0.000, respectively). Total amounts of antivenin correlated with LES-12 (correlation co-efficiency 0.558, p<0.05). However, factors associated with symptom progression were not revealed. Conclusion: Initial snakebite symptoms might progressively worsen within hours despite acceptable initial antivenin therapy. Therefore, re-evaluation within several hours must be considered if when the initial snakebite symptoms are minimal or mild.

• Journal of The Korean Society of Clinical Toxicology
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• v.20 no.2
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• pp.45-50
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• 2022

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.

• Archives of Plastic Surgery
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• v.46 no.1
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• pp.69-74
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• 2019

Background Local symptoms and signs of snake envenomation mimic the clinical features of compartment syndrome. It is important to measure the intracompartmental pressure to diagnose compartment syndrome. In this study, we present our experiences of confirming compartment syndrome and performing fasciotomy in snakebite patients based on high intracompartmental pressure findings. Methods The medical records of patients who visited the trauma center of Wonju Severance Christian Hospital from January 2010 to December 2015 for the management of venomous snakebite were retrospectively reviewed. Starting in 2014, fasciotomy was performed in patients with an intracompartmental pressure of more than 40 mmHg in addition to the clinical symptoms of compartment syndrome. Results A total of 158 patients with snakebite came to the hospital within 48 hours for treatment. Most patients (110 patients) were bitten at the upper extremities (69.6%). Since 2014, 33 out of 59 patients were suspected to have compartment syndrome, and their intracompartmental pressures were measured. Seventeen of those patients had a high intracompartmental pressure (average, 49.6 mmHg; range, 37-88 mmHg), and fasciotomy was performed. Conclusions In this study, as many as 10.8% of all cases were in need of fasciotomy when compartment syndrome was diagnosed by measuring the intracompartmental pressure. Previously, it was reported that fasciotomy was not required in many cases of compartment syndrome originating from snakebite. However, some patients may develop very severe compartment syndrome, requiring fasciotomy.

• Journal of Pharmacopuncture
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• v.2 no.1 s.2
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• pp.73-91
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• 1999

This study was carried out to invastigate the researches of Snake Venom and snakes which used in treatment 1. The fist literature that used the snake for treatment is Shin Nong Ben Cao Jing 2. Composition of Snake Venom is consist of Enzymatic proteins ; Phospholipase A(A1-2), Protease, L-amino acid oxidase etc, and Non-enzymatic proteins ; Crotamine(Cytolysin), Proteolytic factor(Hematoxin), Crotoxin(Neurotoxin) etc. 3. Main toxins in Snake Venom are Hematoxin, Cytolysin, Neurotoxin and Cardiotoxin. Lethal dose 50 value of Agkistrodon brevicaudus is $45.87{\mu}g$/18g, Agkistrodon saxatilis is $10.28{\mu}g$/18g, Agkistrodon ussuriensis is $8.68{\mu}g$/18g, therefore Agkistrodon ussuriensis has strongist Snake Venom of all in Korea. 4. Pharmacological actions of Snake Venom are anticoagulation, thrombolytic function, hypotensor etc. 5. Systemic syndromes and signs after snakebite are Dizziness(25.7%), Vomitting(23.1%), Fever(22%), Visual disturbance(18%), Headache(17.7%) and Dyspnea(17.6%), etc. 6. Local syndrome and sign after snakebite is Discoloration(54.2%), Bleeding(20.2%), Bullae(10.7%), Skinulcer(10.8%), etc. 7. Pathological syndromes after snakebite are WBC increase, Urine protein, Urine sugar, Haematuria and elevation of S-GDT, S-GPT etc. These syndromes are leaded by Hematoxin and Cytolysin. 8. Complication signs after snakebite are Cellulitis, Gastritis, Lympoma, Abscess etc. 9. Common function of Viperidae(Agkistrodon acutus or Zaocys dhumnades etc) is expelling the wind(祛風), removing obstruction in the channels(通絡), antipastic function(止痙). And it is used in order to cure hemiparesis, hemiplegia, facial palsy and CVA disease, etc. 10. Using way of snake for medical treatment is various like Herbal alchol therapy, pill, powder and injection etc. The Study on the Snake Venom should be carried out continuously for using of medical treatment.

• Journal of The Korean Society of Clinical Toxicology
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• v.20 no.2
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• pp.51-57
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• 2022

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.

• Journal of Veterinary Clinics
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• v.24 no.3
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• pp.449-452
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• 2007

A 2 year-old intact male Shih-tzu dog was presented with a history of snakebite on the left upper lip. He was depressed and had swelling, erythema and pain around the left muzzle. Both mandibular lymph nodes were swollen. Fang marks were not clear, but there were scratch wounds and prolonged bleeding. Hemogram revealed neither thrombocytopenia nor echinocytosis. Increased CK value in serum chemistry and myoglobinuria in urine analysis meant muscle injury. With careful monitoring, fluid, corticosteroid, antihistamine and antibiotics were administered. After the application of ice pack and suction, local symptoms changed for the worse. However, any other systemic disorders were not identified. After 5 days, the facial swelling had resolved completely.

• Journal of The Korean Society of Clinical Toxicology
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• v.4 no.2
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• pp.137-142
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• 2006

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.

• Natural Product Sciences
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• v.26 no.4
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• pp.259-267
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• 2020

Snakebite is a severe medical, economic, and social problem across the world, mostly in the tropical and subtropical area. These regions of the globe have typical of the world's venomous snakes present where access to prompt treatment is limited or not available. Snake venom is a complex mixture of toxin proteins like neurotoxin and cardiotoxin, and other enzymes like phospholipase A2 (PLA2), haemorrhaging, transaminase, hyaluronidase, phosphodiesterase, acetylcholinesterase, cytolytic and necrotic toxins. Snake venom shows a wide range of biological effects like anticoagulation or platelet aggregation, hemolysis, hypotension and edema. Phospholipase A2 is the principal constituent of snake venom; it catalyzes the hydrolysis of the sn-2 position of membrane glycerophospholipids to liberate arachidonic acid, which is the precursor of eicosanoids including prostaglandins and leukotrienes. The information regarding the structure and function of the phospholipase A2 enzyme may help in treating the snakebite victims. This review article constitutes a brief description of the structure, types, mechanism occurrence, and tests of phospholipase A2 and role of components of medicinal plants used to inhibit phospholipase A2.

• Journal of The Korean Society of Clinical Toxicology
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• v.15 no.1
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• pp.1-10
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• 2017

Purpose: This study was conducted to identify predictors of serious poisoning in patients with snake bite based on initial findings. Methods: We conducted a retrospective study of patients with snake bite who were treated at the emergency department between January 2010 and December 2016. The patients were divided into two groups according to the severity of symptoms based on the traditional snakebite severity grading scale. The mild poisoning group (MP) was classified as those who had a grade I snakebite severity during the hospital stay, and the severe poisoning group (SP) was classified as patients who had grade I at the time of admission, but progressed to grade II-IV during hospitalization. Initial clinical manifestations and laboratory findings of the two groups were compared. Results: Bite to hospital time intervals of SP were longer than those of MP (p=0.034), and the local effect score (LES) was higher in SP (p<0.001). Laboratory analyses revealed that creatine phosphokinase (p=0.044), creatine phosphokinase MB isoenzyme (CK-MB, p=0.011) and serum amylase (p=0.008) were significantly higher in SP. LES, CK-MB and serum amylase were significant prognostic predictors as indicated by univariate logistic regression analysis. Multivariate analysis revealed the following two significant predictors: LES (odds ratio=3.983, p<0.001) and serum amylase (odds ratio=1.020, p=0.017). Conclusion: In managing cases of snake bites, clinical manifestations and laboratory findings must be carefully evaluated. LES and serum amylase are predictive factors for severe poisoning, which is especially important to rapid determination of the intensive care of the patient.

• Journal of the Korean Society of Food Science and Nutrition
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• v.27 no.5
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• pp.968-972
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• 1998

Allium tuberosum Rotter(Liliaceae) is a perennial herb of which leaves are used for food. Leek has been reported to have pharmacological effects including alleviations of abdominal pain, diarrhea, hematemesis, snakebite, and asthma. To investigate the effect of dietary leek supplementation on the drug-metaboizing enzymes, quinone reductase(QR) and arylhydrocarbon hydroxylase(AHH) activities in the liver, stomach, small intestine and lung, and on the plasma testosterone and dihydrosterone hormone levels, mice were fed 2% and 5% leek diets for 8 weeks. Quinone reductase, an anticarcinogenic enzyme, was significantly induced in stomach, small intestine, and lung but slightly lowered in hepatic tissue in the experimental groups compared to control group. Arylhydrocarbon hydroxylase activity, involved in bioactivation of procarcinogens, was significantly decreased in liver and lung. Leek feeding led to the reduction in the plasma level of dihydrotestosterone which is associated with the incidence of prostate cancer. These findings support the potential chemopreventive activity of leek supplementation.