Case report Case report Snakebite Snakebite Snakebite Snakebite • A 50 years old woman • 1 day before hospitalization date, she was bitten on the dorsum of the left foot. • 2 hours after envenomation, the symptoms appeared. • Ptosis, difficulty in swallowing secretion, dypnoea, respiratory paralysis • She was intubated Snake bite Snake bite On admission: • She’s alert, pupil enlargement (cranial nerve palsy) • Generalized flaccid paralysis • Respiratory depression (requiring mechanical ventilation) • Local tissue injury: no pain or swelling Snakebite Snakebite Laboratory results: • RBC: 4.3; WBC: 15.000, neut 89%, platelet: 239.000 • BUN: 2,7; Creat: 64, Na + : 135; K + : 3.5; Cl - : 102; CK: 326 • No coagulopathy Snakebite Snakebite 2 days later: • Na + : 120, K + : 3.4, Cl - : 90 • Serum osmolality: 258 • Urine osmolality: 974 mosmol/kg • Urine Na + : 282 • Urine output: 2,5-3 lit/24h snakebite snakebite Managemant: • Normal + Hypertonic saline • Hypertonic feedings (salt) • Antibiotic • Fully recovered • Hospitalization course: 9 days • Sympathetic stimulating BUFOTOXIN BUFOTOXIN Bufotoxin Bufotoxin • A 42 years old man • 9 th , november, 2004, ate bufo meat and eggs • After 15 minutes: abdominal pain, nausea, vomit, diarrhea. • Feel faint, tight in the chest bufotoxin bufotoxin • ECG: Management: • Decontamination • Atropin • Spacemaker • Fully recovered . Case report Case report Snakebite Snakebite Snakebite Snakebite • A 50 years old woman • 1 day