Abstract
Russell's viper (RVV) is an important tropical venomous snake. In severe envenomous cases, acute renal failure (ARF) can be seen. Here, the author performs this ministudy to document the management of ARF among reported Thai patients. A literature review on the papers concerning ARF due to RVV in Thailand was performed. Based on this study, hemodialysis and specific antivenom administration shows more favorable outcome than peritoneal dialysis.
Russell's viper is an important tropical venomous snake. Southeast Asia is an important endemic area for this dangerous snake. Pathophysiologic effects of Russell's viper venom (RVV) on renal function are reported. The evidence in experimental animals on the mechanisms of venom action in relation to changes in either extrarenal or intrarenal factors is considered.Citation[1] In severe cases, acute renal failure (ARF) can be seen. However, the guideline for management of ARF due to RVV has never been clarified.
Here, the author performs this ministudy to document the management of ARF among reported Thai patients. A literature review on the papers concerning ARF due to RVV in Thailand was performed using database of the published works cited in the Index Medicus and Science Citation Index. The author also reviewed the published works in all 256 local Thai journals, which are not included in the international citation index, for the report of ARF due to RVV in Thailand. The reports that contained no complete data were excluded for further analysis.
According to this review, there are three reportsCitation[2-4] covering 12 Thai patients with confirmed diagnosis of ARF due to RVV. Concerning the management of these cases, 8 patients were treated by hemodialysis, 2 were treated with specific antivenom, and the other 2 were treated with peritoneal dialysis. Overall, case fatality rate was 16.7% (2/12). Of interest, all death cases were the cases treated with peritoneal dialysis. Based on these data, hemodialysis and specific antivenom administration shows more favorable outcome than peritoneal dialysis. Therefore, in management of ARF due to RVV, the author does not recommend peritoneal dialysis.
References
- Chaiyabutr N., Sitprija V. Pathophysiological effects of Russell's viper venom on renal function. J Nat Toxins. 1999;8:351-358. [PUBMED], [INFOTRIEVE], [CSA]
- Hutachitta T., Tacchaphaitul M., Pimvern S., Pleumpanupat P., Bhuapirom R. Russell's viper bite: report of 2 cases. Bull Dept Med Serv. 1986;11:317–322. [CSA]
- Hutachita T. Renal involvement in Russell's viper bite. Bull Nephrol Soc Thai 1986;6:20. [CSA]
- Sangcharysirisuk A. The result of hemodialysis in acute renal failure patients caused by Russell's viper siamense bite. Reg 8 Med J. 1996;4:17-26. [CSA]