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- Symposium Clinical Toxinology and Envenoming ACCIDENTS CAUSED BY CROTALUS SNAKES BENEDITO BARRAVIERA Professor Titular de Infectologia da UNESP Pesquisador do CEVAP [email protected] Crotalus genus (6 sub-species) Crotalus durissus terrificus, collilineatus, cascavella, ruruima, marajoensis, trigonicus. Crotalus durissus terrificus Caudisona durissa terrifica Distribution in Brazil Crotalus durissus terrificus, collilineatus, cascavella, ruruima, marajoensis, trigonicus. EPIDEMIOLOGY GENUS OF SNAKE Bothrops – 86,16% Crotalus – 8,94% Lachesis – 2,39% Micrurus – 0,63% Others – 1,88% SITE OF THE BITE Legs – 62,75% Arms – 12, 15% Others – 25,1% MONTHS OF OCCURRENCE December to May - summer SEX, AGE AND PROFESSION Male – 76,84% Female – 23,16 Age – 15 to 49 years (64,0%) Rural worker EPIDEMIOLOGY Guia de Vigilância Epidemiológica, Caderno 14, 24p. 2008. CENTER FOR THE STUDY OF VENOMS AND VENOMOUS ANIMALS CEVAP- UNESP Objectives: Promote education, research and extension education in the context of Toxinology (science of toxins from microorganisms, plants and animals). EPIDEMIOLOGY Venomous snakes donated to CEVAP between 2002 and 2009 Crotalic envenoming Clinical aspects 1-Neurotoxic activity neurotoxic symptoms Crotalus durissus terrificus Local bite Ptosis, Diplopia and blurred vision Midriasis NEUROTOXICITY Crotalus durissus terrificus Crotalus durissus terrificus Crotalic envenoming Clinical aspects 2-Systemic rhabdomyolyses skeletal muscle Crotalus durissus terrificus Rhabdomyolysis Myoglobinuria Increase of CPK, DHL, AST and ALT enzymes Rhabdomyolysis Crotalus durissus terrificus Crotalic envenoming Clinical aspects 3-Bleeding and Clotting disturbance Epistaxes Crotalus durissus terrificus Gingival bleeding Crotalic envenoming Clinical aspects 4-Renal failure Crotalus durissus terrificus Tubular necrosis causing renal failure Crotalic envenoming Clinical aspects 5-Liver toxicity Crotalus durissus terrificus Liver cells with mitochondrial edema Increase of Alanine aminotransferase enzyme Liver necrosis Liver with edema “Acute envenoming syndrome” SPECIFIC ANTIVENOM CROTALUS TREATMENT -Mild accident - 10 (100 mg) anticrotalic venom ampules by intravenous route without allergic test; -Moderate accident - 20 (200 mg) anticrotalic venom ampules by intravenous route without allergic test; -Severe accident - 30 (300 mg) anticrotalic venom ampules by intravenous route without allergic test. SUPPORTIVE TREATMENT 1-Hospitalize the patient for at least 24 hours; 2-Make Clotting Test after 12 hours to evaluate clotting disturbance and indicate, if necessary, more antivenom; 3-Clean and wash the bite region; 4-Hidrate to prevent renal failure with Manitol 20%, four times a day for at least 5 days. 5-Increase pH with Sodium bicarbonate 5% , 50 ml by oral route, four times a day. 5-Give antibiotic prophylaxis – cefuroxime 125 to 250 mg twice a day, for 5 to 7 days; 6-Indicate tetanus immunoprophylaxis; 7-If renal failure occurs hemodyalisis. Esta aula está disponível no seguinte endereço: Pela atenção, Muito obrigado !!! Site: www.jvat.org.br/barraviera/index.htm Email: [email protected]