Differences in Clinical Profiles of Patients with Protobothrops mucrosquamatus and Viridovipera stejnegeri Envenoming in Taiwan

Yen-Wen Chen Department of Respiratory Therapy, Taipei Veterans General Hospital; Center for Drug Evaluation, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital; Department of Medicine, School of Medicine, National Yang-Ming University; Department of Surgery, Taoyuan Veterans Hospital; Toxicology Center of China Medical University Hospital; Department of Medicine, School of Medicine, China Medical University; Institute of Emergency and Critical Care Medicine, National Yang-Ming University; Department of Emergency Medicine, Taichung Veterans General Hospital; Department of Environmental and Occupational Medicine, School of Medicine, National Yang-Ming University; Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taiwan

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Min-Hui Chen Department of Respiratory Therapy, Taipei Veterans General Hospital; Center for Drug Evaluation, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital; Department of Medicine, School of Medicine, National Yang-Ming University; Department of Surgery, Taoyuan Veterans Hospital; Toxicology Center of China Medical University Hospital; Department of Medicine, School of Medicine, China Medical University; Institute of Emergency and Critical Care Medicine, National Yang-Ming University; Department of Emergency Medicine, Taichung Veterans General Hospital; Department of Environmental and Occupational Medicine, School of Medicine, National Yang-Ming University; Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taiwan

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Yen-Chia Chen Department of Respiratory Therapy, Taipei Veterans General Hospital; Center for Drug Evaluation, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital; Department of Medicine, School of Medicine, National Yang-Ming University; Department of Surgery, Taoyuan Veterans Hospital; Toxicology Center of China Medical University Hospital; Department of Medicine, School of Medicine, China Medical University; Institute of Emergency and Critical Care Medicine, National Yang-Ming University; Department of Emergency Medicine, Taichung Veterans General Hospital; Department of Environmental and Occupational Medicine, School of Medicine, National Yang-Ming University; Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taiwan

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Dong-Zong Hung Department of Respiratory Therapy, Taipei Veterans General Hospital; Center for Drug Evaluation, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital; Department of Medicine, School of Medicine, National Yang-Ming University; Department of Surgery, Taoyuan Veterans Hospital; Toxicology Center of China Medical University Hospital; Department of Medicine, School of Medicine, China Medical University; Institute of Emergency and Critical Care Medicine, National Yang-Ming University; Department of Emergency Medicine, Taichung Veterans General Hospital; Department of Environmental and Occupational Medicine, School of Medicine, National Yang-Ming University; Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taiwan

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Chien-Kuang Chen Department of Respiratory Therapy, Taipei Veterans General Hospital; Center for Drug Evaluation, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital; Department of Medicine, School of Medicine, National Yang-Ming University; Department of Surgery, Taoyuan Veterans Hospital; Toxicology Center of China Medical University Hospital; Department of Medicine, School of Medicine, China Medical University; Institute of Emergency and Critical Care Medicine, National Yang-Ming University; Department of Emergency Medicine, Taichung Veterans General Hospital; Department of Environmental and Occupational Medicine, School of Medicine, National Yang-Ming University; Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taiwan

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David Hung-Tsang Yen Department of Respiratory Therapy, Taipei Veterans General Hospital; Center for Drug Evaluation, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital; Department of Medicine, School of Medicine, National Yang-Ming University; Department of Surgery, Taoyuan Veterans Hospital; Toxicology Center of China Medical University Hospital; Department of Medicine, School of Medicine, China Medical University; Institute of Emergency and Critical Care Medicine, National Yang-Ming University; Department of Emergency Medicine, Taichung Veterans General Hospital; Department of Environmental and Occupational Medicine, School of Medicine, National Yang-Ming University; Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taiwan

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Chun-I Huang Department of Respiratory Therapy, Taipei Veterans General Hospital; Center for Drug Evaluation, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital; Department of Medicine, School of Medicine, National Yang-Ming University; Department of Surgery, Taoyuan Veterans Hospital; Toxicology Center of China Medical University Hospital; Department of Medicine, School of Medicine, China Medical University; Institute of Emergency and Critical Care Medicine, National Yang-Ming University; Department of Emergency Medicine, Taichung Veterans General Hospital; Department of Environmental and Occupational Medicine, School of Medicine, National Yang-Ming University; Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taiwan

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Chen-Hsen Lee Department of Respiratory Therapy, Taipei Veterans General Hospital; Center for Drug Evaluation, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital; Department of Medicine, School of Medicine, National Yang-Ming University; Department of Surgery, Taoyuan Veterans Hospital; Toxicology Center of China Medical University Hospital; Department of Medicine, School of Medicine, China Medical University; Institute of Emergency and Critical Care Medicine, National Yang-Ming University; Department of Emergency Medicine, Taichung Veterans General Hospital; Department of Environmental and Occupational Medicine, School of Medicine, National Yang-Ming University; Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taiwan

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Lee-Min Wang Department of Respiratory Therapy, Taipei Veterans General Hospital; Center for Drug Evaluation, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital; Department of Medicine, School of Medicine, National Yang-Ming University; Department of Surgery, Taoyuan Veterans Hospital; Toxicology Center of China Medical University Hospital; Department of Medicine, School of Medicine, China Medical University; Institute of Emergency and Critical Care Medicine, National Yang-Ming University; Department of Emergency Medicine, Taichung Veterans General Hospital; Department of Environmental and Occupational Medicine, School of Medicine, National Yang-Ming University; Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taiwan

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Chen-Chang Yang Department of Respiratory Therapy, Taipei Veterans General Hospital; Center for Drug Evaluation, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital; Department of Medicine, School of Medicine, National Yang-Ming University; Department of Surgery, Taoyuan Veterans Hospital; Toxicology Center of China Medical University Hospital; Department of Medicine, School of Medicine, China Medical University; Institute of Emergency and Critical Care Medicine, National Yang-Ming University; Department of Emergency Medicine, Taichung Veterans General Hospital; Department of Environmental and Occupational Medicine, School of Medicine, National Yang-Ming University; Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taiwan

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Envenoming by Protobothrops mucrosquamatus and Viridovipera stejnegeri accounts for the majority of venomous snakebites in Taiwan. We conducted a retrospective study to systematically examine the clinical manifestations and responses to antivenom therapy after P. mucrosquamatus and V. stejnegeri envenoming. Information on demographic characteristics, treatments, and systemic/local complications were abstracted from medical charts between 1991 and 2006. One hundred forty-nine patients with P. mucrosquamatus envenoming and 51 with V. stejnegeri envenoming were eligible for the final analysis, and they differed in terms of patient age, bite site, local bruising, proportion of patients needing ≥ 3 vials of antivenom, and mean hospital stay. Univariate analysis revealed that P. mucrosquamatus envenoming had a higher risk of developing rhabdomyolysis, cellulitis, necrosis, and skin graft. Our findings suggested that P. mucrosquamatus envenoming was associated with a greater risk of severe clinical events, and monitoring for major clinical complications would be recommended.

Author Notes

Reprint requests: Chen-Chang Yang, Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, 201, Shih-Pai Road Sec. 2, Taipei 112, Taiwan, E-mail: ccyang@vghtpe.gov.tw.
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