RESUMO
Clinical and laboratory data from patients who applied a tourniquet (tourniquet group, n = 45) and who did not apply it (non-tourniquet group, n = 52) after being bitten by Crotalus durissus were compared. The patients were treated with 100-200 ml of Crotalus durissus antivenom. The gender, age, time elapsed between bite and hospital admission, dose of antivenom and the frequency of local paresthesia, myalgia and palpebral ptosis did not differ between the two groups. Plasma creatine kinase enzyme activity and partial thromboplastin time, plasma whole venom and crotoxin concentrations and the frequency of acute renal and respiratory failure and number of deaths also did not differ between both groups. Data from this study show the ineffectiveness of tourniquet applied by patients in the fields to reduce the severity of Crotalus durissus envenoming.
Assuntos
Antivenenos/uso terapêutico , Crotoxina/efeitos adversos , Mordeduras de Serpentes/terapia , Torniquetes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Criança , Pré-Escolar , Creatina Quinase/sangue , Crotoxina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Insuficiência Renal/prevenção & controle , Insuficiência Respiratória/prevenção & controleRESUMO
Thirty-seven patients envenomed by Crotalus durissus were classified into three groups according to the interval between the bite and hospital admission (delta T): group 1 (n = 14, delta T < 4 hr), group 2 (n = 14, delta T > 4 hr < 8 hr) and group 3 (n = 9, delta T > 8 hr). Venous blood from these patients was sampled for biochemical and hematological analysis and for whole venom, crotoxin and antivenom enzyme-linked immunosorbent assays before antivenom treatment (T0) and at 1 hr (T1), 6 hr (T6), 12 hr (T12) and 24 hr (T24) after the start of antivenom therapy. The patients were treated with 100-200 ml (10-20 ampules) of C. durissus antivenom. Whole venom and crotoxin were detected in 13 (92.8%) and 11 (78.6%) of 14 group 1 patients, respectively, in 11 (78.6%) and six (42.9%) of 14 group 2 patients, respectively, and in two (22.2%) and one (11.1%) of nine group 3 patients, respectively, before antivenom treatment. Data from this study show that whole venom and crotoxin were not detected in most of patients when the time elapsed between the bite and hospital admission was greater than 8 hr, and crotoxin was not detected in most of the patients who were admitted to the hospital at times ranging from 4 to 8 hr after the snakebite. Plasma whole venom, crotoxin and antivenom levels measured over time in these patients show the efficacy of antivenom treatment, since circulating venom and crotoxin were no longer detected 1 hr after antivenom therapy and high antivenom titers persisted for at least 24 hr after serotherapy.