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Acute Kidney Injury and Rhabdomyolysis After Protobothrops flavoviridis Bite: A Retrospective Survey of 86 Patients in a Tertiary Care Center
Acute kidney injury (AKI) is the main cause of death for victims of hematoxic snakebites. A few studies have described improvement in AKI rates in snakebite cases, but the reasons for the improvement have not been investigated. Eighty-six patients with Protobothrops flavoviridis bites admitted to a single center from January 2003 through March 2014 were included in the study. Clinical variables, including age, sex, blood pressure (BP), and serum creatinine (S-Cre), on admission were compared between patients with and without AKI. One patient died of disseminated intravascular coagulation following AKI (mortality rate 1.1%). Six patients developed AKI with rhabdomyolysis. Systolic BP, S-Cre, serum creatine kinase, white blood cell count, and platelet count differed significantly between the AKI and non-AKI groups (P = 0.01). Three of the six patients were physically challenged to a degree that made it difficult for them to move or communicate, and these difficulties likely exacerbated the severity of snakebite complications. Our study demonstrated that the risk of snakebite-induced AKI for physically challenged patients was high. To further reduce mortality due to snakebite-induced AKI, we need to make it possible for physically challenged patients to receive first aid sooner.
Author Notes
Authors' addresses: Hiroaki Nishimura, Shuichirou Kawahira, and Ichiro Kagara, Division of Blood Purification, Kagoshima Prefectural Ohshima Hospital, Kagoshima, Japan, E-mails: nishimura.hiroaki@gmail.com, kawashu999@yahoo.co.jp, and himawarisaita5215@yahoo.co.jp. Hideki Enokida and Masayuki Nakagawa, Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan, E-mails: enokida@m.kufm.kagoshima-u.ac.jp and nakagawa@m.kufm.kagoshima-u.ac.jp. Hiroshi Hayami, Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan, E-mail: bass@m.kufm.kagoshima-u.ac.jp.