Clinical Profile and Pharmacological Management of Snakebites in Community Care Units: A Retrospective Study Using Two Military Hospital Databases in South Thailand
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Subjects
2.2. Data Collection
2.3. Statistical Analysis
3. Results
3.1. Baseline Characteristics of Participants
3.2. Characteristics of Patients Stratified by Antivenom Treatment and Clinical Management
3.3. Pharmacological Treatments and Other Treatments of Patients with Snakebites
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Thepsatrisrisunthon | Wachirawut | Total |
---|---|---|---|
n (%) | n (%) | n (%) | |
Year | |||
2012–2015 | 2 (3.7) | 3 (5.6) | 5 (9.3) |
2016–2019 | 3 (5.6) | 14 (25.9) | 17 (31.5) |
2020–2022 | 8 (14.8) | 24 (44.4) | 32 (59.3) |
Age (years) | |||
10–29 | 9 (16.7) | 6 (11.1) | 15 (27.8) |
30–49 | 3 (5.6) | 11 (20.4) | 14 (25.9) |
50–69 | 1 (1.9) | 19 (35.2) | 20 (37) |
>70 | 0 (0) | 5 (9.3) | 5 (9.3) |
Median (IQR) | 25 (23–30) | 57 (42–65) | 49 (28–63) |
Gender | |||
Male | 9 (16.7) | 31 (57.4) | 40 (74.1) |
Female | 4 (7.4) | 10 (18.5) | 14 (25.9) |
Admitted/Referred | |||
Emergency department | 13 (24.1) | 39 (72.2) | 52 (96.3) |
Referred | 0 (0) | 2 (3.7) | 2 (3.7) |
Fang mark | 13 (24.1) | 40 (74.1) | 53 (98.1) |
Bitten area | |||
Arm | 0 (0) | 2 (3.7) | 2 (3.7) |
Hand | 2 (3.7) | 12 (22.2) | 14 (25.9) |
Leg | 0 (0) | 8 (14.8) | 8 (14.8) |
Foot | 10 (18.5) | 19 (35.2) | 29 (53.7) |
Chest | 1 (1.9) | 0 (0) | 1 (1.9) |
Admission duration (day) | |||
Median (IQR) | 1 (0–2) | 3 (3–4) | 3 (2–4) |
Snake type | |||
Malayan pit viper (Caloselasma rhodostoma) | 3 (5.6) | 34 (63.0) | 37 (68.5) |
Cobra (Naja spp.) | 2 (3.7) | 1 (1.9) | 3 (5.6) |
Other non-venomous snakes | 4 (7.4) | 0 (0) | 4 (7.4) |
Unidentified species | 4 (7.4) | 6 (11.1) | 10 (18.5) |
Clinical Manifestation * (n = 41) | |||
Local pain | 6 (66.7) | 24 (75.0) | 30 (73.2) |
Swelling | 6 (66.7) | 31 (96.9) | 37 (90.2) |
Local hematoma | 4 (44.4) | 2 (6.3) | 6 (14.6) |
Bleb | 0 (0) | 2 (6.3) | 2 (4.9) |
Compartment syndrome | 0 (0) | 1 (3.1) | 1 (2.4) |
Muscle weakness | 0 (0) | 1 (3.1) | 1 (2.4) |
Respiratory failure | 0 (0) | 1 (3.1) | 1 (2.4) |
Ptosis | 0 (0) | 1 (3.1) | 1 (2.4) |
Characteristics | Did Not Receive Antivenom | Received Antivenom | p-Value |
---|---|---|---|
n (% of 30 Patients) | n (% of 24 Patients) | ||
Year | 0.027 a | ||
2012–2015 | 4 (13.3) | 1 (4.2) | |
2016–2019 | 5 (16.7) | 12 (50.0) | |
2020–2022 | 21 (70.0) | 11 (45.8) | |
Hospital | 0.002 a | ||
Wachirawut | 18 (60.0) | 23 (95.8) | |
Thepsatrisrisunthon | 12 (40.0) | 1 (4.2) | |
Age (years) | |||
Median (IQR) | 45.5 (27.0–63.0) | 51.5 (33.5–63.0) | 0.433 b |
Sex | 0.445 a | ||
Male | 21 (70.0) | 19 (79.2) | |
Female | 9 (30.0) | 5 (20.8) | |
Time before arrival (min) | |||
Median (IQR) | 20 (15–40) | 17.5 (10-–0) | 0.385 b |
Admission duration | |||
Median (Min–max) | 2 (0–5) | 3 (1–19) | <0.001 b |
INR (n = 36) | |||
Median (IQR) | 1 (1.0–1.1) | 1 (0.9–1.1) | 0.325 b |
Platelet (×109/L) (n = 50) | |||
Mean ± SD | 257 ± 71.5 | 211 ± 91.7 | 0.053 c |
Serum creatinine (n = 49) | |||
Mean ± SD | 0.9 ± 0.2 | 0.9 ± 0.2 | 0.553 c |
Serum sodium (mmol/L) (n = 44) | 0.924 a | ||
Hyponatremia (<135) | 2 (8.7) | 2 (9.5) | |
Normal (135–145) | 21 (91.3) | 19 (90.5) | |
Hypernatremia (>145) | N/A | N/A | |
Serum potassium (mmol/L) (n = 44) | 0.202 a | ||
Hypokalemia (<3.5) | 3 (13.0) | 6 (28.6) | |
Normal (3.5–5.1) | 20 (87.0) | 15 (71.4) | |
Hyperkalemia (>5.1) | N/A | N/A | |
Serum chloride (mmol/L) (n = 44) | 0.905 a | ||
Hypochloremia (<96) | N/A | N/A | |
Normochloremia (96–106) | 20 (87.0) | 18 (85.7) | |
Hyperchloremia (>106) | 3 (13.0) | 3 (14.3) | |
Serum bicarbonate (mmol/L) (n = 44) | 0.260 a | ||
Hypobicarbonatemia (<22) | 4 (17.4) | 2 (9.5) | |
Normal (22–29) | 19 (82.6) | 17 (81.0) | |
Hyperbicarbonatemia (>29) | N/A | 2 (9.5) | |
Serum CPK (U/L) (n = 5) | 0.833 a | ||
Normal | 1 (100.0) | 2 (50.0) | |
Elevated (>200) | 0 (0.0) | 2 (50.0) | |
Clinical Manifestation (n = 41) | |||
Local pain | 14 (63.6) | 16 (84.2) | 0.138 a |
Swelling | 19 (86.4) | 18 (94.7) | 0.368 a |
Local hematoma | 4 (18.2) | 2 (10.5) | 0.489 a |
Bleb | 1 (4.5) | 1 (5.3) | 0.915 a |
Compartment syndrome | 0 (0.0) | 1 (5.3) | 0.276 a |
Muscle weakness | 0 (0.0) | 1 (5.3) | 0.276 a |
Respiratory failure | 0 (0.0) | 1 (5.3) | 0.276 a |
Ptosis | 0 (0.0) | 1 (5.3) | 0.276 a |
Characteristics | Thepsatrisrisunthon | Wachirawut |
---|---|---|
n (%) | n (%) | |
Number of administered patients | 1 (1.9) | 23 (42.6) |
Indications | ||
Prolonged VCT | 0 (0) | 9 (16.7) |
Unclotted 20 WBCT | 1 (1.9) | 10 (18.5) |
Platelet <50 × 109/L | 0 (0) | 0 (0) |
INR >1.2 | N/A | 4 (7.4) |
Systemic bleeding | 0 (0) | 2 (3.7) |
Compartment syndrome | 0 (0) | 2 (3.7) |
Antivenom type | ||
MPV monovalent AV | 1 (1.9%: 3 vials) | 21 (38.9%: 3–20 vials/person) |
Hemato polyvalent AV | 0 (0) | 1 (1.9%: 3 vials) |
Cobra monovalent AV | 0 (0) | 0 (0) |
Neuro polyvalent snake AV | 0 (0) | 1 (1.9%: 20 vials) |
Appropriate administration (n = 24) | ||
With indication | 1 (100.0% of 1 patients) | 21 (91.3% of 23 patients) |
Given with no indication | N/A | 2 (8.7% of 23 patients) |
Appropriate dosage | 1 (100.0% of 1 patients) | 23 (100.0% of 23 patients) |
Adverse reactions | ||
Itchiness | 0 (0) | 2 (8.7% of 23 patients) |
Rash | 0 (0) | 3 (13.0% of 23 patients) |
Characteristics | Thepsatrisrisunthon | Wachirawut |
---|---|---|
n (%) | n (%) | |
Pain control | ||
Paracetamol | 8 (14.8) | 37 (68.5) |
Other NSAIDs | 2 (3.7) | 2 (3.7) |
Pethidine | 0 (0.0) | 1 (1.9) |
Other (Orphenadrine + paracetamol) | 3 (5.6) | 0 (0.0) |
Antibiotics | ||
Amoxicillin/Clavulanic acid | 3 (5.5) | 41 (75.9) |
Dicloxacillin | 5 (9.3) | 0 (0.0) |
Tetanus toxoid (dT/TT) | 3 (5.5) | 38 (70.4) |
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Lertsakulbunlue, S.; Suebtuam, R.; Eamchotchawalit, T.; Chantkran, W.; Chaisakul, J. Clinical Profile and Pharmacological Management of Snakebites in Community Care Units: A Retrospective Study Using Two Military Hospital Databases in South Thailand. Trop. Med. Infect. Dis. 2023, 8, 346. https://doi.org/10.3390/tropicalmed8070346
Lertsakulbunlue S, Suebtuam R, Eamchotchawalit T, Chantkran W, Chaisakul J. Clinical Profile and Pharmacological Management of Snakebites in Community Care Units: A Retrospective Study Using Two Military Hospital Databases in South Thailand. Tropical Medicine and Infectious Disease. 2023; 8(7):346. https://doi.org/10.3390/tropicalmed8070346
Chicago/Turabian StyleLertsakulbunlue, Sethapong, Ratchakarn Suebtuam, Theethach Eamchotchawalit, Wittawat Chantkran, and Janeyuth Chaisakul. 2023. "Clinical Profile and Pharmacological Management of Snakebites in Community Care Units: A Retrospective Study Using Two Military Hospital Databases in South Thailand" Tropical Medicine and Infectious Disease 8, no. 7: 346. https://doi.org/10.3390/tropicalmed8070346