A case of mamushi bite associated with acute renal failure and respiratory failure

Abstract

A 75–year–old woman, who visited our clinic after being bitten on her right first and second toes by a mamushi in August 2007, was admitted to the hospital to follow her clinical course. With progression of swelling, acute renal failure due to rhabdomyolysis, increases in serious inflammatory findings, and deterioration of respiratory condition developed. Thus the patient was referred to our emergency and critical care medical center. Mamushi bite was suspected based on observation of the course of symptoms, and mamushi antivenin and Cepharanthine were administered, though about one and a half days had elapsed since being bitten. The CPK value that had increased up to 112200 IU/l was promptly normalized after the administration of the antivenin. Acute renal failure, respiratory failure, and impaired hepatic function were confirmed, so that sustained hemodialysis and management with respirator were performed. The urine volume gradually increased from the 3^rd week since being bitten, and the patient was freed from hemodialysis on the 4^th week.
The most common cause of deaths due to mamushi bites is acute renal failure that can result from mioglobulinemia due to rhabdomyolysis or renal toxicity carried by mamushi toxin itself. In this paper we present a patient with mamushi bite whose life was successfully saved by intensive cares including hemodialysis and management with artificial respirator in an acute phase.