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ACCIDENTS CAUSED BY CROTALUS SNAKES

- Symposium - Clinical Toxinology and Envenoming. ACCIDENTS CAUSED BY CROTALUS SNAKES. BENEDITO BARRAVIERA Professor Titular de Infectologia da UNESP Pesquisador do CEVAP bbviera@jvat.org.br. Crotalus genus (6 sub-species)

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ACCIDENTS CAUSED BY CROTALUS SNAKES

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  1. - Symposium - Clinical Toxinology and Envenoming ACCIDENTS CAUSED BY CROTALUS SNAKES BENEDITO BARRAVIERA Professor Titular de Infectologia da UNESP Pesquisador do CEVAP bbviera@jvat.org.br

  2. Crotalus genus (6 sub-species) Crotalus durissus terrificus, collilineatus, cascavella, ruruima, marajoensis, trigonicus. Crotalus durissus terrificus Caudisona durissa terrifica

  3. Distribution in Brazil Crotalus durissus terrificus, collilineatus, cascavella, ruruima, marajoensis, trigonicus.

  4. EPIDEMIOLOGY SITE OF THE BITE Legs – 62,75% Arms – 12, 15% Others – 25,1% GENUS OF SNAKE Bothrops – 86,16% Crotalus – 8,94% Lachesis – 2,39% Micrurus – 0,63% Others – 1,88% MONTHS OF OCCURRENCE December to May - summer SEX, AGE AND PROFESSION Male – 76,84% Female – 23,16 Age – 15 to 49 years (64,0%) Rural worker

  5. EPIDEMIOLOGY Guia de Vigilância Epidemiológica, Caderno 14, 24p. 2008.

  6. 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).

  7. EPIDEMIOLOGY Venomous snakes donated to CEVAP between 2002 and 2009

  8. 1-Neurotoxic activity neurotoxic symptoms Crotalic envenoming Clinical aspects Crotalus durissus terrificus Midriasis Local bite Ptosis, Diplopia and blurred vision

  9. NEUROTOXICITY Crotalus durissus terrificus Crotalus durissus terrificus

  10. 2-Systemic rhabdomyolyses skeletal muscle Crotalic envenoming Clinical aspects Crotalus durissus terrificus Rhabdomyolysis Myoglobinuria Increase of CPK, DHL, AST and ALT enzymes

  11. Crotalus durissus terrificus Rhabdomyolysis

  12. 3-Bleeding and Clotting disturbance Crotalic envenoming Clinical aspects Epistaxes Crotalus durissus terrificus Gingival bleeding

  13. 4-Renal failure Crotalic envenoming Clinical aspects Crotalus durissus terrificus Tubular necrosis causing renal failure

  14. 5-Liver toxicity Crotalic envenoming Clinical aspects Crotalus durissus terrificus Liver cells with mitochondrial edema Increase of Alanine aminotransferase enzyme Liver necrosis Liver with edema

  15. “Acute envenoming syndrome”

  16. -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. SPECIFIC ANTIVENOM CROTALUS TREATMENT

  17. SUPPORTIVE TREATMENT 1-Hospitalize thepatient for atleast 24 hours;2-MakeClottingTestafter 12 hours to evaluateclottingdisturbanceandindicate, ifnecessary, more antivenom;3-Cleanand wash the bite region;4-Hidrate to prevent renal failurewith Manitol 20%, four times a day for atleast 5 days. 5-Increase pH withSodiumbicarbonate 5% , 50 ml by oral route, four times a day. 5-Giveantibioticprophylaxis – cefuroxime 125 to 250 mgtwice a day, for 5 to 7 days;6-Indicatetetanusimmunoprophylaxis;7-If renal failureoccurshemodyalisis.

  18. Esta aula está disponível no seguinte endereço: Pela atenção, Muito obrigado !!! Site: www.jvat.org.br/barraviera/index.htm Email: bbviera@jvat.org.br

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