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Forensic and Clinical Toxicology
Published in P. K. Gupta, Brainstorming Questions in Toxicology, 2020
A 12-year-old boy had an alleged history of snake bite and presented to the hospital with inability to open eyes well and difficulty in breathing. He is very anxious and is having tachycardia and tachypnea. On examination, the bite mark cannot be visualized, and there is no swelling of the limb. He has bilateral ptosis. His 20-min whole-blood clotting test is good quality. What is the next course of action?
Bites and stings
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
History of snakebite and presence of bite marks help in the diagnosis. Identification of the biting snake and time of bite helps in determining the progression of signs and symptoms. A 20-minute whole blood clotting test (20 WBCT) is a reliable bedside test of coagulation.
Clinical Toxicology of Snakebite In Africa and The Middle East / Arabian Peninsula
Published in Jürg Meier, Julian White, Handbook of: Clinical Toxicology of Animal Venoms and Poisons, 2017
Neurotoxic signs often respond slowly, after several hours, or unconvincingly. Cardiovascular effects such as hypotension and sinus bradycardia (for example after bites by Bitis and Vipera species) may respond within 10–20 minutes. Spontaneous systemic bleeding usually stops within 15–30 minutes and blood coagulability is restored within about six hours if an adequate dose of antivenom has been given. The 20 minute whole blood clotting test (see above) should be used to monitor the dose of antivenom in patients with coagulopathy. If the blood remains incoagulable six hours after the first dose, the dose should be repeated and so on, every six hours, until blood coagulability is restored.
Comparison of bedside clotting tests for detecting venom-induced consumption coagulopathy following Sri Lankan viper envenoming
Published in Clinical Toxicology, 2022
Supun Wedasingha, Anjana Silva, Sisira Siribaddana, Kanishka Seneviratne, Geoffrey K. Isbister
The 20-min whole blood clotting test (WBCT-20) is the most widely used bedside clotting test globally. Currently, there is no consensus in regards to the standardization of the WBCT-20, including the tube type, the diameter of the tube, the volume of blood collected and other factors that could influence the performance of the test [8]. In the original descriptions, as well as in subsequent validation studies, the observation times for bedside clotting tests have not been evaluated for the detection of VICC, and the commonly used 20-minute observation time is somewhat arbitrary [8]. The WBCT-20 has a high specificity and moderate to good sensitivity in some settings [9,10]. It is necessary to do an assessment of its validity in other geographical settings [11]. The capillary blood clotting test (CBCT) is another bedside test that has been used in some settings, but has not been evaluated previously [12].
Mass spectrometric analysis to unravel the venom proteome composition of Indian snakes: opening new avenues in clinical research
Published in Expert Review of Proteomics, 2020
Abhishek Chanda, Ashis K. Mukherjee
Even in this modern age of twenty-first century, snakebite continues to be a matter of medical concern in the Indian subcontinent. It is ironic to note that India is one of the world’s leading producers of snake antivenom albeit this country has witnessed the highest incidence of snakebite mortality in the world [1]. The usual protocol practiced by clinicians in India for the treatment of snakebite begins with the observation of signs or symptoms of envenomation, enquiring about the time of bite and identification of the snake specimen (if made available) responsible for the bite [7]. The initial investigation begins with the scrutiny of the fang marks, condition of the tourniquet (if employed), and 20-min whole blood clotting test (20WBCT) to determine the coagulation status of the patient at an interval of every 30 min for the first 4 h. Depending upon the status of the investigation and condition of the patient, the decision of antivenom administration is made by the physicians; however, the number of antivenom vials to be administered to bite victim is not well standardized [7]. Henceforth, a thorough investigation and further clinical research on snakebite are required to optimize the judicious dose of antivenom to be administered to snakebite patient, which not only will be economical but will induce less adverse serum reactions in patient. Administration of unnecessarily high doses of antivenom is not ethical and has attracted controversy.
Bothrops snakebites in the Amazon: recovery from hemostatic disorders after Brazilian antivenom therapy
Published in Clinical Toxicology, 2020
Sâmella Silva de Oliveira, Eliane Campos Alves, Alessandra dos Santos Santos, Elizandra Freitas Nascimento, João Pedro Tavares Pereira, Iran Mendonça da Silva, Jacqueline Sachett, Hiochelson Najibe dos Santos Ibiapina, Lybia Kássia Santos Sarraf, Jorge Carlos Contreras Bernal, Luciana Aparecida Freitas de Sousa, Mônica Colombini, Hedylamar Oliveira Marques, Marcus Vinicius Guimarães de Lacerda, Ana Maria Moura-da-Silva, Hui Wen Fan, Luiz Carlos de Lima Ferreira, Ida Sigueko Sano Martins, Wuelton Marcelo Monteiro
Patients’ blood samples were collected at T0, T12, T24, T48 and on discharge. Clotting time was determined by the 20 min whole blood clotting test [23–25]. Blood was defined as unclottable when no clot was formed within 20 min and clottable when a solid or partial clot was formed within 20 min. Platelet counts and mean platelet volume (MPV) were carried out on samples containing potassium EDTA as the anticoagulant. Two percent v/v Bothrops-Lachesis antivenom was added to the samples to neutralize Bothrops venom present in the sample, and counts were determined in an automated cell counter (Sysmex Corp., Kobe, Japan). Thrombocytopenia was defined by a platelet count below 150 × 109/L. Low and high MPV were defined when values were below 7.4 fL and above 10.4 fL, respectively.