Treatment Evolution Using Fabotherapics in Patients Suffering from Snakebites at the General Hospital of Tampico, Tamaulipas State, México.

García-Willis, Carlos E.

Hospital General de Tampico, Tampico, Tamps. México

Many patients suffering from snakebites are admitted to the Hospital General de Tampíco of the Health Ministry, coming from the rural areas of Huasteca of Tamaulipas, Veracruz, San Luis Potosí, and Hidalgo.

Many species of venomous snakes are known, although the most frequent in our region come from the Viperidae and the Bothrops species of the Crotalidae family, mainly the nahuyaca (mahuaquite, four noses). Their venoms contain toxic compounds with active substances that include proteolytic enzymes, low-molecular weight polypeptides, neurotoxins, hemotoxins, proteases etc, which are responsible for the clinical symptoms in these patients.

In our hospital, we used to treat these patients with a single vial of viperine antivenom, according to the Health Ministry guidelines, with unsatisfactory results.

For this reason, we began a trial to evaluate the usefulness of multi-dose treatment with viperine antivenom.

MATERIALS AND METHODS:

The trial was divided into two parts. A retrospective review, Group A, of records from snake-bitten patients admitted between July 1982 and March 1993. These patients were attended in accordance with the Health Ministry guidelines (one single vial of viperine antivenom, half IM and the other half at the bite site), independent of the clinical signs and evolution, in addition to the complementary treatment (plasma, steroids, anti-histamine drugs, analgesics, antibiotics, etc).

The second prospective review, Group B, included all patients admitted to the Hospital General de Tampico with snakebite diagnosis between April 1993 and December 1999, who were classified, studied, and treated according to the modified scale of Christopher and Rodning, applying the first dose (impregnation) of viperine antivenom IV and continuing with the administration of five vials every four hours (maintenance) until the venom effects disappeared, independent of the evolution time. In this group, the viperine antivenom was diluted in 250 ml of saline solution at 0.9%.

Variables such as age, sex, anatomic place affected, domicile, time of envenoming, symptoms, laboratory alterations, treatment offered, complications, and evolution in terms of survival or death were compared.

RESULTS:

This study included 392 patients, 53 in Group A (30 children and 23 adults) and 339 in Group B (101 children and 238 adults). Most of patients were male (64.79%) and more than 75% were adult.

The majority of patients attending the Hospital General de Tampico were from the Huasteca of Veracruz (54%), with varying percentage from other Huasteca states of the country. Most envenomings occurred in the morning (95%), during spring and summer time (98%), and 80% of the bites were in the pelvic limbs.

Clinical manifestations were classified into local and systemic. The most frequent were fang marks, local pain, and edema (100%), and the most consistent systemic clinical manifestations were nausea, vomiting, and cardiac rhythm alterations (96-97%).

The most frequently altered laboratory test was CPR (100%).

On the Christopher and Rodning scale, more than 80% of the patients admitted to the Hospital General de Tampico showed envenomation grades II or III, 7.3% of patients grade IV.

The number of vials used varied according to the envenomation grade, although in the ER of our Hospital we used between 11 and 20 vial of viperine antivenom (fabotherapic) in more than 60% of the patients.

All patients in Group A had were hospitalized for more than 10 days in comparison with Group B where only 6% were hospitalized for more than 10 days and 79%being hospitalized for 1 to 5 days.

All symptoms in Group B patients receiving multiple-dose viperine antivenom treatment showed changes (P = 0.000).

Finally, mortality in Group A was 25.4% and in Group B 2.0%.

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