Changes in serial laboratory test results in snakebite patients: when can we safely exclude envenoming?
Summary of "Changes in serial laboratory test results in snakebite patients: when can we safely exclude envenoming?"
OBJECTIVES:
To determine which laboratory tests are first associated with severe envenoming after a snakebite, when (ie, how long after the bite) the test results become abnormal, and whether this can determine a safe observation period after suspected snakebite. DESIGN, PATIENTS AND
SETTING:
Prospective cohort study of 478 patients with suspected or confirmed snakebite recruited to the Australian Snakebite Project from January 2002 to April 2009, who had at least three sets of laboratory test results and at least 12 hours of observation in hospital after the bite. Severe envenoming was defined as venom-induced consumption coagulopathy (VICC), myotoxicity, neurotoxicity or thrombotic microangiopathy. MAIN OUTCOME
MEASURES:
International normalised ratio (INR), activated partial thromboplastin time (aPTT), creatine kinase (CK) level, and neurological examination.
RESULTS:
There were 240 patients with severe envenoming, 75 with minor envenoming and 163 non-envenomed patients. Of 206 patients with VICC, 178 had an INR > 1.2 (abnormal) on admission, and the remaining 28 had an INR > 1.2 within 12 hours of the bite. Of 33 patients with myotoxicity, a combination of CK > 250 U/L and an abnormal aPTT identified all but two cases by 12 hours; one of these two was identified within 12 hours by leukocytosis. Nine cases of isolated neurotoxicity had a median time of onset after the bite of 4 hours (range, 35 min - 12 h). The combination of serial INR, aPTT and CK tests and repeated neurological examination identified 213 of 222 severe envenoming cases (96%) by 6 hours and 238 of 240 (99%) by 12 hours.
CONCLUSION:
Laboratory parameters (INR, aPTT and CK) and neurological reassessments identified nearly all severe envenoming cases within 12 hours of the bite, even in this conservative analysis that assumed normal test results if the test was not done.
Affiliation
Emergency Department, Gold Coast Hospital, Gold Coast, QLD, Australia. geoff.isbister@gmail.com.
Journal Details
This article was published in the following journal.
Name: The Medical journal of Australia
ISSN: 0025-729X
Pages: 285-90
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20819048
- DOI: http://dx.doi.org/
Medical and Biotech [MESH] Definitions
Laboratory Proficiency Testing
Assessments aimed at determining agreement in diagnostic test results among laboratories. Identical survey samples are distributed to participating laboratories, with results stratified according to testing methodologies.
Logical Observation Identifiers Names And Codes
A vocabulary database of universal identifiers for laboratory and clinical test results. Its purpose is to facilitate the exchange and pooling of results for clinical care, outcomes management, and research. It is produced by the Regenstrief Institute. (LOINC and RELMA [Internet]. Indianapolis: The Regenstrief Institute; c1995-2001 [cited 2002 Apr 2]. Available from http://www.regenstrief.org/loinc)
Diagnostic Test Approval
The process of gaining approval by a government regulatory agency for DIAGNOSTIC REAGENTS AND TEST KITS. This includes any required preclinical or clinical testing, review, submission, and evaluation of the applications and test results, and post-marketing surveillance.
Leukocyte Adherence Inhibition Test
Test for cell-mediated antitumor immunity and related serum blocking factors based on the finding that leukocytes from cancer patients, but not from controls, when mixed in vitro with antigenic extracts of tumors of the same histological type, undergo a diminution in their normal adherence to glass surfaces. Sera from tumor-bearing patients block the LAI reaction of their own leukocytes or those of other patients with the same type of tumor.
Point-of-care Systems
Laboratory and other services provided to patients at the bedside. These include diagnostic and laboratory testing using automated information entry.
PubMed Articles
A patient with snakebite presenting with thrombophlebitis-like appearance and DIC.
A snakebite is a serious and important problem in tropical and subtropical cities. A vast majority of snakebites are nonvenomous. However, venomous snakebites may cause local tissue destruction, neuro...
Management of venomous snakebite injury to the extremities.
Pit vipers (subfamily Crotalinae) are responsible for most venomous snakebites in the United States. The mixture of proteins with cytotoxic, proteolytic, and/or neurotoxic enzymes in snake venom varie...
Processing speed deficits in patients with multiple sclerosis (MS) are usually assessed with tests requiring rapid serial processing. Two such tests were compared here, the Paced Auditory Serial Addit...
Clinical toxinology is a specialized area of clinical medicine focused on the pathophysiology, diagnosis, treatment, and prevention of diseases caused by animal, plant, and fungal toxins. This review...
Venomous snakebites in the Croatian North Dalmatia region.
AIM: The aim of this research project is to analyze the epidemiological, clinical and laboratory attributes of venomous snakebites and to ascertain the timely and efficient treatment at the location w...
Clinical Trials
The sphincter of Oddi is a circular band of muscle which controls the flow of pancreatic juices and bile into the small intestine. Abnormal function of the Sphincter of Oddi, known as Sphi...
Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT II)
The purpose of this study is to test whether physicians can make more informed treatment, admission, and discharge decisions related to patient care by having serial Triage® BNP test resu...
Evaluation of the Periotest Method in Dental Traumatology
Background/Aims: The Periotest® method represents a technique for objective tooth mobility assessment. The aims of this study were: 1. receiving information about normal Periotest® value...
Accuracy of Whole-Blood Testing for Rapid Detection of Pregnancy
It is common practice in the emergency medicine department to rapidly assess pregnancy status through the use of either urine or serum in pregnancy tests. Using whole blood instead of urin...
ALTROPANE® SPECT Imaging in Patients With Parkinson Disease
After a screening evaluation including baseline clinical laboratory testing, a physical and neurological evaluation, subjects will be asked to undergo an injection of ALTROPANE® followed...
