Clinical features of 60 consecutive ICU-treated patients envenomed by Bungarus multicinctus
Hung, H.Tran.; Höjer, J.; Du, N.Thi.
Southeast Asian Journal of Tropical Medicine and Public Health 40(3): 518-524
2009
ISSN/ISBN: 0125-1562 PMID: 19842438 Document Number: 630190
In northern Vietnam, Bungarus multicinctus is the only krait of medical importance. We report 60 consecutive patients admitted to an ICU in Hanoi during 2000-2003 because of envenoming by B. multicinctus. Their mean age was 33 years (range 12-67), 77% were male. The majority were agricultural workers, 69% of the snakebites occurred during the night. The mean length of time until the first symptom developed was 3 hours (range 0.5-24 hours). The only sign at the site of the bite was fang marks, which were noted in 90%. The most common neuromuscular symptoms were ptosis and mydriasis (93%), ophthalmoplegia (82%), jaw weakness (90%), pharyngeal pain (83%), palatal palsy (90%), neck muscle paralysis (85%), limb paralysis (85%), and paralysis of the respiratory muscles (87%). No antivenom was available. Fifty-two patients (87%) needed mechanical ventilation for a mean of 8 days. The most surprising laboratory finding was a high rate of significant hyponatremia (42%). The mean duration of the ICU stay was 12 days and the hospital mortality was 7%. According to the Poisoning Severity Score criteria, 54 patients (90%) were classified as severe or lethal envenoming.