To investigate the effectiveness of mamushi anti-venom, we examined the relationships between the length of hospital stay (LOS) and the anti-venom administration, LOS and intervals of the bite and administration of the anti-venom, and severity of the bite and initial laboratory data. The sample of this study was a total of 46 cases who were admitted for mamushi bite from 2003 to 2013 to our hospital. Data was collected from medical records retrospectively. The average LOS was significantly shorter in those treated with the anti-venom than without the antivenom (6.7 days vs 14.4 days, respectively). Out of the thirty six cases with the anti-venom therapy, the average LOS was significantly shorter if the anti-venom was administered within 6 hours of the bite than when administered after 6 hours (4.8 days vs 10.4 days, respectively). There was a moderate positive correlation between the severity of the bite and increase in ALT initial. Our results suggest that administration of the anti-venom reduces the length of hospitalization, especially when administered within 6 hours of the mamushi bites. A standardized treatment guideline for mamushi bite is anticipated to define appropriate time to administer the anti-venom from the onset, biochemical data to predict severity of the injury at the initial assessment, by collecting patient data.
INTRODUCTION:A multicenter retrospective survey of patients poisoned by herbicides containing glyphosate salts in Japan was conducted to identify differences in symptoms and outcome of poisoning.METHODS:Participants were patients who were transported to emergency facilities between October 2006 and March 2014 after consuming herbicides containing glyphosate potassium salt (GlyK(+)) (the K-group) or other glyphosate salts (the O-group). Questionnaires were mailed to 38 emergency facilities that agreed to participate in the study.RESULTS:Serum potassium levels upon arrival were significantly higher (p < 0.01), and abnormal electrocardiogram findings were significantly more common (p < 0.01) in the K-group (n = 55) than in the O-group (n = 62). Conversely, acute lung injury (ALI) including acute respiratory distress syndrome (ARDS) (p = 0.05) and liver injury (LI) (p < 0.01) were significantly more common during hospitalization in the O-group, although no significant differences in the duration of hospital stay (p = 0.92) or outcomes (p = 0.95) were observed between the two groups.DISCUSSION AND CONCLUSION:The ingestion of products containing glyphosate isopropylamine or ammonium salts, and polyoxyethyleneamine (POEA) as a surfactant, can cause severe organ injury. Physicians should note that the ingestion of products containing glyphosate potassium salt and surfactants other than POEA can cause hyperkalemia, potentially leading to fatal arrhythmias or cardiac arrest.
A 55-year-old man attempted suicide by ingesting tolfenpyrad, emulsion formulation insecticide, and organophosphorus pesticide emulsion, each three gulps. He was found lying on the floor and his family called an ambulance an hour later from ingesting. On arrival at our hospital, his Glasgow Coma Scale score was 14 (E3V5M6), his vital signs were stable, and he was able to converse. Activated charcoal and laxatives were injected through a gastric tube, and continuous administration of pralidoxime iodide was started. After hospitalization, he complained of nausea and his consciousness level decreased immediately. Endotracheal intubation was performed, and mechanical ventilation management was started Subsequently, he experienced bradycardia leading to transient cardiopulmonary arrest. Return of spontaneous circulation was achieved after one cycle of cardiopulmonary resuscitation. While blood pressure was stabilized with continuous catecholamine administration, blood gas analysis revealed severe lactic acidosis, which gradually aggravated. Electroencephalography performed 16.5 hours after the suicide attempt showed flat waves, and he wa's suspected brain dead. He died about 37 hours after the suicide attempt.
