Influential factors affecting prognosis of snakebite patients management: Kaohsiung Chang Gung Memorial Hospital experience.

The objective of this study was to determine the most influential factors affecting the prognosis of snakebite patients in Kaohsiung Chang Gung Memorial Hospital.A thorough review of the medical records of poisonous snakebite from June 1986 to November 1999 was carried out in this retrospective study.Of the identified snakes in 39 bite victims, 70% of these cases were hemorrhagic type: Trimeresurus stejnegeri 20/27, T. mucrosquamatus 6/27, and Agkistrodon acutus 1/27; 28% were neurotoxic type: Naja naja atra 6/11 and Bungarus multicinctus 5/11; and 2% was mixed type: Vipera russelli formosensis 1/39. Three of four acute renal failure victims were bitten by T. mucrosquamatus. Two of the 5 victims bitten by B. multicinctus required endotracheal intubation to maintain their respiration. Five patients received skin grafting, 3 of whom were bitten by Naja naja atra. Most of our patients (55%) received only a single dose of antivenin, and 83% (29/35) of the antivenin was given within 6 hours after the bite; the antivenin infusion was finished in less than 2 hours in most cases (33/36).Bites from Trimeresurus stejnegeri are the most common poisonous snakebite recorded in our emergency department. T. mucrosquamatus is prominent in causing bleeding tendency and acute renal failure. Bungarus multicinctus is more prominent than Naja naja atra in causing acute respiratory failure. The dosage of antivenin used to treat patient bitten by cobra was less than that recommended by the poison control center, and the complication of skin necrosis requiring skin grafting was more severe than that of the other species.