Rare complication of snake bite
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Snake bite : A Rare Complication myocardial injury
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Rare complication of snake bite
- 1. RARE CASE OF SNAKE BITE DR MANOHARI R M4 UNIT
- 2. HISTORY • A previously healthy 43 year old male • Presented 6hrs after a snake bite in his right foot just below the medial malleolus • Complains of pain around the site of bite • Chest pain with sweating of 1 hour duration • Abdominal Pain • Nausea
- 3. • No history of DM • No history of HTN • No history of cardiac disease • No history of Liver/Renal disease
- 4. EXAMINATION • Irritable • Confused • Anxious • Fang mark + just below Right medial malleolus • Cellulitis Right leg upto 5cm below the right knee joint – progressive • Profuse sweating • No ptosis • No neck weakness • SBC ? • No hematuria /No excess Bleeding from wound
- 5. • Pulse rate 120/mt low volume thready • BP 70/40 mm Hg • CVS S1, S2 Normal, Tachycardia + • RS BAE+ , Clear, Tachypneic, SpO2 95% with Room Air • P/A Epigastric tenderness + • NS Irritable, anxious , No FND
- 6. ECG
- 9. •CK – MB 85 IU/L NORMAL UPTO 25 IU/L
- 10. What to do..
- 11. • Rapid resuscitation with fluids ( crystalloids) • Anti tetanus toxoid • Antibiotics • Inotropes ASV THROMBOLYSIS
- 14. • Rowlands JB, Mastaglia FL, Kakalus BA, Hainsworth D. Clinical and pathological aspects of a fatal case of mulga (Pseudechis australis) snakebite. Med J Aust 1969;1:226-30. Copley AL, Banerjee S, Devi A. Studies of snake venoms on blood coagulation. Thromb Res 1973;2:487-508.
- 15. Dissanayake P, Sellahewa KH. Acute myocardial infarction in a patient with Russell’s viper bite. Ceylon Med J 1996;41:67-8. Hoffman A, Levi O, Orgad U, Nyska A. Myocarditis following envenoming with viperae palaestinae in two horses. Toxicon 1993;31:1623-8.
- 17. Proposed mechanisms • DIC causing thrombus formation in coronaries • Direct vasculitis • Sarafotoxins causing coronary vasoconstriction • Coronary spasm due to endothelins in venom • Hypovolemic shock due to bleeding • Hypercoagulability in consumption coagulopathy • Hyperviscosity secondary to hypovolemia induced hemoconcentration • Direct cardiotoxic effect on myocardium
- 18. BACK TO THE CASE..
- 20. • Started on 10 vials of ASV • Blood pressure dropping • Maintained on boluses of Adrenaline • Patient had an episode of blood tinged vomiting (25-50ml) • 4 units FFP transfused • 8 more vials of ASV issued under inotrope support • Patients chest pain reduced • Symptomatically better • BP improved to >110/70mm without inotropes in 12hrs • Chest clear
- 23. Day 2
- 24. Day 2
- 25. ECHOCARDIOGRAM • Mild Hypokinesia of inferior wall • Normal LV function
- 29. DAY S.CREATININE S.UREA 1 0.9 31 2 2.5 64 3 3.5 98 4 2.6 105 5 2.8 91 6 2.0 64 7 1.6 57 8 1.8 46 10 1.2 26 0 0.5 1 1.5 2 2.5 3 3.5 4 0 2 4 6 8 10 12S.CREATININE DAY
- 30. AT DISCHARGE • GC stable • No Complaints • Renal functions returned to normal • Cellulitis settled