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. 2021 Nov 30:17:1257-1266.
doi: 10.2147/TCRM.S337199. eCollection 2021.

Malayan Pit Viper Envenomation and Treatment in Thailand

Thunyaporn Tangtrongchitr  1   2 , Suthimon Thumtecho  1   3 , Jiratchaya Janprasert  4 , Kitisak Sanprasert  2 , Achara Tongpoo  1 , Yuvadee Tanpudsa  1 , Satariya Trakulsrichai  1   5 , Winai Wananukul  1   6 , Sahaphume Srisuma  1   6
Affiliations

Malayan Pit Viper Envenomation and Treatment in Thailand

Thunyaporn Tangtrongchitr et al. Ther Clin Risk Manag. .

Abstract

Introduction: The Malayan pit viper (MPV; Calloselasma rhodostoma) is a hematotoxic snake found in all regions of Thailand and many countries in Southeast Asia. Treatment of MPV envenomation varies among facilities due to their capabilities.

Materials and methods: This study was a retrospective review of patients with MPV envenomation who were reported to the Ramathibodi Poison Center from 1 July 2016 to 30 June 2018.

Results: Of the 167 patients (median age, 40.5 years; range, 1.3-87.0 years) bitten by an MPV, the most common bite site was the foot (29.3%). Most patients reached the hospital within 1 hour of being bitten. One-hundred fifty-six patients (93.4%) had local effects from envenomation; 17 patients (10.2%) had severe local complications including necrotizing fasciitis (3.0%) and compartment syndrome (7.2%). Systemic effects such as hemorrhage and abnormal hemostasis occurred in 147 patients (88.0%). Additional effects included abnormal venous clotting time in 123 patients (73.7%), unclotted 20-minute whole blood clotting time in 57 patients (34.1%), low platelet counts (<50,000/µL) in 29 patients (17.4%), prolonged international normalized ratio (>1.2) in 51 patients (30.5%), and systemic bleeding in 14 patients (8.4%). The median onset of bleeding disorder was 6 hours. Monitoring for 24, 48, and 49 hours after bite enabled detection of systemic effects in 94.2%, 99.3%, and 100.0%, respectively. Three hundred fifteen courses of antivenin were administered to 144 patients (86.2%). All the patients who received antivenin recovered from bleeding disorder. Only 7.0% of antivenin doses were administered without Thai Red Cross indications. Allergic reactions from antivenin occurred in 34.7% of the 144 patients. One hundred thirty patients (77.8%) received antibiotics, and 32 patients (19.2%) required surgical management, including debridement and fasciotomy.

Conclusion: MPV envenomation results in local and systemic effects. Most systemic effects were abnormal clotting test results. Most patients reported onset of bleeding disorder within 48 hours.

Keywords: Malayan pit viper; antivenin; hematotoxin; onset of abnormality; snake venom.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Patients with Malayan pit viper bite reported to Ramathibodi Poison Center during July 2016 to June 2018. (A) Malayan pit viper bites by region of Thailand. (B) Malayan pit viper bites by month and season. (C) Malayan pit viper bites by time of day (O’clock).
Figure 2
Figure 2
Grading of local effects after Malayan pit viper bite reported to Ramathibodi Poison Center during July 2016 to June 2018.
Figure 3
Figure 3
Cumulative percentage of cases with systemic effect over time.
See this image and copyright information in PMC

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