독사 교상 후 발생하는 횡문근 융해증
Rhabdomyolysis induced by venomous snake bite
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Despite previous studies reporting the development of rhabdomyolysis (RM), this affliction tends to be neglected as an envenomation sign in South Korea. The current retrospective study investigates the prevalence and prognosis of RM after a snakebite. We further searched for predictors of snakebite-induced RM, which can be observed at presentation. Methods: This study included 231 patients who presented to the ED within 24 hours after a snakebite. The patients were classified according to the severity of RM, and the data, comprising baseline characteristics and clinical course including the level of creatine kinase (CK), were collected and compared according to the severity of RM. Results: The prevalence of RM and severe RM were determined to be 39% and 18.5%, respectively. Compared to the group without RM or with mild RM, the group with severe RM had a higher grade of local swelling, a higher frequency of acute kidney injury and neurotoxicity, and a greater need for renal replacement therapy and vasopressor administration. However, the incidence of acute renal injury in the RM group was 7.7%, with two patients needing renal replacement therapy. No mortalities were reported at discharge. Results of the multinomial logistic regression model revealed that the WBC levels are significantly associated with the risk of severe RM. Conclusion: RM should be considered the primary clinical sign of snake envenomation in South Korea, although it does not seem to worsen the clinical course. In particular, physicians should pay attention to patients who present with leukocytosis after a snakebite, which indicates the risk of developing RM, regardless of the CK level at presentation.
Abstract
Purpose: Despite previous studies reporting the development of rhabdomyolysis (RM), this affliction tends to be neglected as an envenomation sign in South Korea. The current retrospective study investigates the prevalence and prognosis of RM after a snakebite. We further searched for predictors of snakebite-induced RM, which can be observed at presentation. Methods: This study included 231 patients who presented to the ED within 24 hours after a snakebite. The patients were classified according to the severity of RM, and the data, comprising baseline characteristics and clinical course including the level of creatine kinase (CK), were collected and compared according to the severity of RM. Results: The prevalence of RM and severe RM were determined to be 39% and 18.5%, respectively. Compared to the group without RM or with mild RM, the group with severe RM had a higher grade of local swelling, a higher frequency of acute kidney injury and neurotoxicity, and a greater need for renal replacement therapy and vasopressor administration. However, the incidence of acute renal injury in the RM group was 7.7%, with two patients needing renal replacement therapy. No mortalities were reported at discharge. Results of the multinomial logistic regression model revealed that the WBC levels are significantly associated with the risk of severe RM. Conclusion: RM should be considered the primary clinical sign of snake envenomation in South Korea, although it does not seem to worsen the clinical course. In particular, physicians should pay attention to patients who present with leukocytosis after a snakebite, which indicates the risk of developing RM, regardless of the CK level at presentation.
참고문헌 (27)
- 임훈, "한국 뱀 교상에 대한 항뱀독소", 대한의사협회지, 56(12), pp.1091~1103 (2013), 대한의사협회
- 강승호, "Does the traditional snakebite severity score correctly classify envenomated patients?", Clinical and Experimental Emergency Medicine, 3(1), pp.34~40 (2016), 대한응급의학회[DOI]
- Shim JH, "Ecological study on poisonous snake and investigation of the venom characteristics, snakebiting frequency in korea", Korean J Environ Ecol, 12, pp.58~77 (1998)
- Williams HF, "The urgent need to develop novel strategies for the diagnosis and treatment of snakebites", Toxins, 11, pp.363~ (2019)
- Moon JM, "The effect of myocardial injury on the clinical course of snake envenomation in South Korea", Clin Toxicol(Phila), 59(4), pp.286~295 (2021)
- 차용성, "Usefulness of delta neutrophil index for early prediction of overt disseminated intravascular coagulopathy in patients with venomous snakebite", Clinical and Experimental Emergency Medicine, 5(2), pp.76~83 (2018), 대한응급의학회[DOI]
- Park KH, "Effectiveness of repeated antivenom therapy for snakebite related systemic complications", J Int Med Res, 47(10), pp.4808~4814 (2019)
- Long B, "An evidence-based narrative review of the emergency department evaluation and management of rhabdomyolysis", Am J Emerg Med, 37(3), pp.518~523 (2019)
- Zutt R, "Rhabdomyolysis: review of the literature", Neuromuscul Disord, 24, pp.651~659 (2014)
- Torres PA, "Rhabdomyolysis : Pathogenesis, diagnosis, and treatment", Ochsner J, 15, pp.58~69 (2015)
- Gupta A, "Rhabdomyolysis : Revisited", Ulster Med J, 90(2), pp.61~66 (2021)
- Yong Jun Jeon, "Risk factor, monitoring, and treatment for snakebite induced coagulopathy: a multicenter retrospective study", Acute and Critical Care, 34(4), pp.269~275 (2019), 대한중환자의학회[DOI]
- Park EJ, "Systemic complications occurring after korean venomous snake bite with focus on hematologic and neurologic complications", J Korean Soc Clin Toxicol, 7, pp.90~96 (2009)
- Moon JM, "Glasgow coma scale score in the prognosis of acute carbamate insecitide intoxication", Clin Toxicol, 50, pp.832~837 (2012)
- 하상욱, "Performance Evaluation of Five Different Disseminated Intravascular Coagulation (DIC) Diagnostic Criteria for Predicting Mortality in Patients with Complicated Sepsis", Journal of Korean Medical Science, 31(11), pp.1838~1845 (2016), 대한의학회
- Sitprija V, "Snake bite, rhabdomyolysis, and renal failure", Am J Kidney Dis, 31(6), pp.l~lii (1998)
- Kularatne SAM, "Enhydrina schistosa(Elapidae : Hydrophiinae)the most dangerous sea snake in Sri Lanka : three case studies of severe envenoming", Toxicon, 77, pp.78~86 (2014)
- Johnston CI, "Australian Sea Snake Envenoming Causes Myotoxicity and Non-Specific Systemic Symptoms-Australian Snakebite Project(ASP-24)", Front Pharmacol, 13, pp.816795~ (2002)
- Vangstad M, "Rhabdmolyolysis : a 10-year retrospective study of paitents treated in a medical department", Eur J Emerg Med, 26, pp.199~204 (2019)
- De Meijer AR, "Serum creatine kinase as predictor of clinical course in rhabdomyolysis : a 5-year intensive care survey", Intensive Care Med, 29, pp.1121~1125 (2003)
- Cabral BMI, "Rhabdomyolysis", dis Mon, 66(8), pp.101015~ (2020)
- Brochard L, "An Official ATS", ERS, SCCM, pp.SRLF Statement : prevention and management of acute renal failure in the ICU patient : an international consensus conference in intensive care medicine, Am J Respir Crit Care Med[DOI]
- Matsumura M, "Rhabdomyolysis and acute renal failure after poisonous snake(Agkistrodon halys blomhoffii)bite", Intern Med, 40(6), pp.551~ (2001)
- Lane R, "Rhabdomyolysis", BMJ (2003)
- Bagley WH, "Rhabdomyolysis", Intern Emerg Med, 2(3), pp.210~218 (2007)
- Geng Y, "Rhabdomyolysis is associated with in hospital mortality in patients with covid-19", Shock, 56(3), pp.360~367 (2021)