Nephrotoxicity Due to Snake Bite

Öz

Viperidae species snakes cause serious local tissue toxicity, and systemic poisoning states such as disseminated intravascular haemolysis. Rarely, acute kidney insufficiency may be seen due to snake bites. An eighteen year old male patient was transported to our clinic due to snake bite in the left f ankle. On admission he was administered three vials of antivenom with respect to his local and systemic poisoning signs. All coagulatioan parameters were normal after antivenom therapy and he was hospitalized. On the second day of hospitalisation his haematocrit and haemoglobin values were decreased and urea and creatinine values were increased and it was thought that these were due to intravascular haemolysis. Additional antivenom administered and fluid therapy was begun. During his hospitalisation renal function tests and hemogram of the patient were followed. He was discharged on the fifth day of hospitalisation with normal urea and creatinin levels. Intravascular haemolysis is an independent risk factor for nephrotoxicity in patients admitted with snake bites. Additional antivenom and aggressive fluid treatment may be beneficial in acute kidney insufficiency in these patients.

Anahtar Kelimeler

• Snake bite, nephrotoxicity, antivenom

Yılan Isırmasına Bağlı Nefrotoksisite

Öz

Viperidae species snakes cause serious local tissue toxicity, and systemic poisoning states such as disseminated intravascular haemolysis. Rarely, acute kidney insufficiency may be seen due to snake bites. An eighteen year old male patient was transported to our clinic due to snake bite in the left f ankle. On admission he was administered three vials of antivenom with respect to his local and systemic poisoning signs. All coagulatioan parameters were normal after antivenom therapy and he was hospitalized. On the second day of hospitalisation his haematocrit and haemoglobin values were decreased and urea and creatinine values were increased and it was thought that these were due to intravascular haemolysis. Additional antivenom administered and fluid therapy was begun. During his hospitalisation renal function tests and hemogram of the patient were followed. He was discharged on the fifth day of hospitalisation with normal urea and creatinin levels. Intravascular haemolysis is an independent risk factor for nephrotoxicity in patients admitted with snake bites. Additional antivenom and aggressive fluid treatment may be beneficial in acute kidney insufficiency in these patients

Anahtar Kelimeler

• Snake bite, nephrotoxicity, antivenom

Kaynakça

1. Açıkalın A, Gökel Y, Kuvandık G, Duru M, Köseoğlu Z, Satar S. The efficacy of low-dose antivenom therapy on morbidity and mortality in snakebite cases. Am J Emerg Med. 2008; 26: 402-7. [CrossRef]
2. Currie BJ. Snakebite in tropical Australia: a prospective study in the “Top End” of the Northern Territory. Med J Aust. 2004; 181: 693-7.
3. Ellenhorn MJ. Envenomation bites and stings. Ellerhorn’s Medi- cal Toxicology. Matthew J. Ellen-horn, MD, Editor. Williams and Wilkins. Baltimore. 2 th ed. 1997; p(72).1737-98.
4. Riley DB, Pizon EA, Ruha MA, Roberts JR, Otten EJ. Snakes and Other Reptiles. Goldfrank’s toxiko-logy. Goldfrank R L, MD, Edi- tor. Mc-graw Hill. 8 th ed. 2002;117: 1643-62
5. Attaphan G, Balaji VM, Naereethan U, Thirumalikolundusubra- manian P. Acute renal failure in snake envenomation: a large pro- spective study. Saudi Kidney Dis Transpl. 2008; 19: 404-10.
6. Alirol E, Sharma KS, Bowaskar SH, Kuch U, Chappuis F. Snake bite in South Asia: a review. PLoS Negl Trop Dis. 2010; 4: e603. [CrossRef]
7. Spiller HA, Bosse GM, Ryan ML. Use of antivenom for snakebites reported to United States poison centers. Am J Emerg Med. 2010; 28: 780-5. [CrossRef]
8. Zager RA, Gamelin LM. Pathogenetic mechanism in experimen- tal hemoglobinuria acute renal failure. Am J Physiol. 1985; 256: F446-55.

9. Zager RA, Foerder CA . Effects of inorganic iron and myoglobin on in vitro proximal tubule lipid peroxidation and cytotoxicity. J Clin Invest. 1992; 89 : 989-95. [CrossRef]