Hematotoxic Manifestations and Management of Green Pit Viper Bites in Thailand

Figures & data

Table 1 Characteristics of GPV Bite Cases

Characteristics	No. of Cases (% of Total 288 Cases)
Gender
Male	181 (62.8)
Female	107 (37.2)
Age in years, median (IQR, range)	40 (22.8–58, 1–97)
Region
Northeast	86 (29.9)
Central	73 (25.3)
Bangkok	59 (20.5)
North	24 (8.3)
South	18 (6.3)
West	17 (5.9)
East	11 (3.8)
Confirmation of GPV bite
GPV or GPV carcass brought to the hospital	162 (56.3)
Patient’s recognition of GPV	102 (35.4)
Undetermined	24 (8.3)

Abbreviations: GPV, green pit viper; IQR, interquartile range.

Figure 1 Numbers of cases of GPV bite reported each month (A) and the time of day (B).

Figure 2 Frequency of each bite site.

Figure 3 Frequency of local swelling severity.

Table 2 Number and Percentage of Cases with Abnormal Results for Each Lab Parameter, and Median Onset of Each Abnormal Test Result and Systemic Bleeding

Parameters Tested (Number of Test Cases)	No. of Cases with Abnormal Results (%)	Time of Onset (h) (IQR, Range)
VCT (244)	111 (45.5)	13 (6–25, 0.2–120)
WBCT (157)	69 (44.8)	9 (2.5–21, 0.3–120)
INR (217)	65 (30.0)	19.5 (8–43, 0.5–120)
Platelets (280)	43 (15.4)	18.75 (10–37.5, 0.3–78)
Fibrinogen (10)	3 (30)	15 (10.5–46.5, 6–78)
Systemic bleeding (13)		11 (2.3–37.5, 1–72)
Overall onset of systemic effects		15 (6–28.3, 0.2–120)

Abbreviations: IQR, interquartile range; INR, international normalized ratio; VCT, venous clotting time; WBCT, whole blood clotting time.

Figure 4 Cumulative percentage of cases detected at a specific time after bite.

Table 3 Characteristics of Antivenom Administration

Characteristics	No. of Cases (% of Total 180 Cases That Received AV)	No. of Courses (% of Total 285 Courses of AV)
Indication
VCT	90 (50)	144 (50.5)
WBCT	55 (30.6)	68 (23.9)
INR	41 (22.8)	46 (16.1)
Platelet	39 (21.7)	45 (15.8)
Systemic bleeding	8 (4.4)	9 (3.2)
Compartment syndrome, upper airway obstruction	3 (1.7)	3 (1.1)
Reasons for appropriateness
Appropriate dose	178 (98.9)	275 (96.5)
Appropriate duration and interval of administration	148 (82.2)	237 (83.2)
Slow administration due to allergic symptoms to AV	12 (6.7)	15 (5.3)

Abbreviations: AV, antivenom; INR, international normalized ratio; VCT, venous clotting time; WBCT, whole blood clotting time.

Table 4 Features and Treatments of Early Reactions After Administration of Antivenoms

Features of Early Reactions to AV	No. of Cases (% of Total 180 Cases That Received AV)	No. of Courses (% of Total 285 Courses of AV)
Cutaneous
Urticaria	30 (16.7)	31 (10.9)
Pruritus	6 (3.3)	6 (2.1)
Angioedema	5 (2.8)	5 (1.7)
Gastrointestinal
Nausea and vomiting	2 (1.1)	2 (0.7)
Respiratory
Chest tightness	17 (9.4)	17 (5.9)
Wheezing	4 (2.2)	4 (1.4)
Hypoxemia	4 (2.2)	5 (1.7)
Dyspnea	2 (1.1)	2 (0.7)
Cardiovascular
Tachycardia	7 (3.9)	7 (2.4)
Hypotension	4 (2.2)	4 (1.4)
Syncope	1 (0.6)	1 (0.3)
Others
Fever with chill	3 (1.7)	3 (1.1)
Drowsy	1 (0.6)	1 (0.3)
Treatments
Adrenaline	14 (7.8)	14 (4.9)
Dexamethasone IV	16 (8.9)	16 (5.6)
Chlorpheniramine IV	31 (17.2)	31 (10.9)
Ranitidine IV	6 (3.3)	6 (2.1)
Hydrocortisone IV	4 (2.2)	4 (1.4)
Meperidine IV	1 (0.6)	1 (0.3)

Abbreviations: AV, antivenom; IV, intravenous.

Table 5 Median Onset of Each Abnormal Test Result and Systemic Bleeding in 34 Pediatric Patients

Parameters Tested (No. of Cases with Abnormal Results)	Time of Onset (Hour) (IQR, Range)
VCT (23)	13.5 (6–20.3, 0.2–48)
WBCT (15)	8 (2–19, 1–77)
INR (13)	21.5 (17–28.5, 0.5–60)
Platelets (5)	23 (18–27, 12–62)
Systemic bleeding (2)	67 (64.5–69.5, 62–72)
Overall (34)	12 (3–21.5, 0.2–62)

Abbreviations: IQR, interquartile range; INR, international normalized ratio; VCT, venous clotting time; WBCT, whole blood clotting time.

Figure 5 Cumulative percentage of hematotoxicity (pediatric) cases detected.