Venom-induced consumption coagulation in a hematotoxin snake bite in East Java, Indonesia: A case report
DOI: https://doi.org/10.33024/minh.v7i11.668
Antivenom Calloselasma Rhodostoma East Java Hematotoxin Snake Bite
Abstract
Background: Located in Southeast Asia, Indonesia is one of the countries with the highest incidence of fatal snakebites in the world. Difficulty in identifying snake species and limited availability of antivenom often pose challenges in treating snakebites.
Purpose: To illustrate a case of consumption coagulation caused by a hematotoxin-containing snake venom.
Method: A case study study describes a snakebite incident managed in the Emergency Department (ED) of a secondary general hospital in Tulungagung, East Java. A 53-year-old male patient presented with pain, swelling, and bleeding in his left thumb, after being bitten by a yellow-brown Bandotan snake, approximately two hours prior to arrival.
Results: The patient was given antivenom therapy according to the guidelines. Patients were also given antitetanus, antibiotics, platelet transfusions and fresh frozen plasma (FFP), supportive therapy, and strict monitoring. in the surgical high care unit (HCU). The patient showed improvement on the fifth day and was discharged on the tenth day.
Conclusion: The use of local polyvalent antivenom combined with antibiotics, antitetanus therapy, platelets, and FFP transfusion has shown promising results in the management of toxin-induced coagulopathy.
Suggestion: Further studies are needed to evaluate the effectiveness of therapy in different age groups, including children, adults, and the elderly. In addition, this study only focused on therapeutic management and did not assess the impact of treatment on organ dysfunction caused by post-treatment lesions.
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References
Alangode, A., Rajan, K., & Nair, B. G. (2020). Snake antivenom: Challenges and alternate approaches. Biochemical Pharmacology, 181, 114135.
ALQuwaiay, F., Alshammari, H., Eltoum, A., Almutairi, H., Alshamari, J., & Ahmed, H. (2022). Unusual Snake bite complications in a 70 year-old woman: A case Report. Med Sci, 26(123).
Berling, I., & Isbister, G. K. (2015). Hematologic effects and complications of snake envenoming. Transfusion medicine reviews, 29(2), 82-89.
Bhalla, G., Mhaskar, D., & Agarwal, A. (2014). A study of clinical profile of snake bite at a tertiary care centre. Toxicology international, 21(2), 203.
Bhaumik, S., Beri, D., Lassi, Z. S., & Jagnoor, J. (2020). Interventions for the management of snakebite envenoming: An overview of systematic reviews. PLoS neglected tropical diseases, 14(10), e0008727.
Demde, R. B., & Patil, M. A. (2020). Coagulation profile in cases of snake bites. Journal of Critical Reviews, 7(12).
Hawa, K. A., Mhaili, J., Boutakioute, B., Idrissi, M. O., & El Ganouni, N. I. (2022). Hemorrhagic stroke revealing a snake bite: A case report. Cureus, 14(1).
Isbister, G. K. (2024). The critical time period for administering antivenom: golden hours and missed opportunities. Clinical Toxicology, 62(5), 277-279.
Ministry of Health of the Republic of Indonesia. (2023). Buku pegangan penanganan gigitan, sengatan hewan berbisa, serta keracunan tanaman dan jamur. Retrieved from: https://kareumbi.wordpress.com/wp-content/uploads/2023/05/buku-pedoman-penangganan-hewan-berbisa-dantumbuhan.pdf
Mohale, S. A., Varma, A. R., Bharadiya, G. R., Acharya, S., & Bawankule, S. A. (2021). A Study of Complications of Poisonous Snake Bites. Journal of Evolution of Medical and Dental Sciences, 10(32), 2602-2609.
Mubarak, R., & Mohapatra, B. N. (2021). Study of coagulation disorders after hemotoxic snake envenomation in a tertiary care center. International Journal of Medical Research, 9(6), 1641-1647.
Patikorn, C., Ismail, A. K., Abidin, S. A. Z., Blanco, F. B., Blessmann, J., Choumlivong, K., & Othman, I. (2022). Situation of snakebite, antivenom market and access to antivenoms in ASEAN countries. BMJ global health, 7(3), e007639.
Pucca, M. B., Knudsen, C., S. Oliveira, I., Rimbault, C., A. Cerni, F., Wen, F. H., & Monteiro, W. M. (2020). Current knowledge on snake dry bites. Toxins, 12(11), 668.
Ralph, R., Faiz, M. A., Sharma, S. K., Ribeiro, I., & Chappuis, F. (2022). Managing snakebite. BMJ, 376.
Simangunsong, D. K., Habib, H., & Simbolon, E. (2024). Pemberian SABU (Serum Anti-Bisa Ular) untuk Kasus Gigitan Ular Awitan Lama dengan Komplikasi Disseminated Intravascular Coagulation (DIC). Cermin Dunia Kedokteran, 51(3), 149-155.
Sriapha, C., Rittilert, P., Vasaruchapong, T., Srisuma, S., Wananukul, W., & Trakulsrichai, S. (2022). Early adverse reactions to snake antivenom: poison center data analysis. Toxins, 14(10), 694.
Tan, C. H., Liew, J. L., Tan, K. Y., & Tan, N. H. (2016). Assessing SABU (Serum Anti Bisa Ular), the sole Indonesian antivenom: A proteomic analysis and neutralization efficacy study. Scientific reports, 6(1), 37299.
Tan, N. H., Tan, K. Y., & Tan, C. H. (2021). Snakebite in Southeast Asia: envenomation and clinical management. In Handbook of Venoms and Toxins of Reptiles (pp. 559-580). CRC Press.
Verma, S., Baveja, P., Thakur, N., Patnaik, S., Tilak, T. V. S. V. G. K., & Mutreja, D. (2023). Young man with alleged snake bite and disseminated intravascular coagulation or a life-threatening but potentially curable malignancy: Clinicopathological correlation. National Medical Journal of India, 36(2).
World Health Organization. (2016). Guidelines for the management of snakebites (2nd ed). Retrieved from: https://apps.who.int/iris/handle/10665/249547
Zeng, L., Liang, Q., Liang, Z., Han, J., Wu, M., Liu, R., & Wang, X. (2022). Effectiveness of clotting factor replacement therapy after antivenom treatment on coagulopathic envenomation following green pit viper bites: a retrospective observational study. BMC Emergency Medicine, 22(1), 9.
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Copyright (c) 2025 Priyo Sasmito, Leli Mulyatiindo, Janno Berty Bradly Bernadus, Nisa Arifani, Novia Dwi Astuti, Fika Indah Prasetya, Nurfanida Librianty, Nandar Wirawan

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