Can Fresh Frozen Plasma Prevent Acute Kidney Injury after Hump-Nosed Viper Bite?

DOI: 10.4236/ojneph.2013.31012    2,811 Downloads   5,183 Views   Citations

ABSTRACT

Hump-nosed viper bite is the commonest venomous snakebite in Sri Lanka. Acute kidney injury (AKI) in association with coagulopathy is an important cause of mortality. Immunomodulating effects of fresh frozen plasma (FFP) could block the nephrotoxic effects of venom; and by replenishing depleted clotting factors resulting from venom induced consumption coagulopathy could offer an additional benefit in offsetting renal injury triggered by haematological disturbances. In a non-randomised observational study carried out from 2005 to 2008 in adults at the National hospital of Sri Lanka, the mean time for resolution of coagulopathy among 42 patients treated with FFP at the inception of coagulopathy was 4.7 hours compared to 18 patients treated with isotonic Saline among whom the mean time for normalisation of coagulopathy was 6.2 hours. None of these 60 patients developed acute renal failure. A separate cohort of 32 patients with coagulopathy after hump-nosed viper bite who had not received FFP during this study period developed acute renal failure and required haemodialysis. In the absence of safe and effective antivenom for hump-nosed viper in Sri Lanka, FFP may be a therapeutic option. FFP if given early to selected patients at inception of coagulopathy may prevent AKI and serve to save lives after hump-nosed viper bites.

Cite this paper

Sellahewa, K. (2013) Can Fresh Frozen Plasma Prevent Acute Kidney Injury after Hump-Nosed Viper Bite?. Open Journal of Nephrology, 3, 70-74. doi: 10.4236/ojneph.2013.31012.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] A. De Silva, “Snakebites in Anuradhapura District,” The Snake, Vol. 13, 1981, pp. 117-130.
[2] S. L. Seneviratne, C. J. Opanayaka, N. S. Ratnayake, K. E. Kumara, A. M. Sugathadasa, N. Weerasuriya, W. A. Wickrama, S. B. Gunatilake and H. J. de Silva, “Use of Antivenom Serum in Snake Bite: A Prospective Study of Hospital Practice in the Gampaha District,” Ceylon Medical Journal, Vol. 45, No. 2, 2000, pp. 65-68.
[3] A. Kasturiratne, A. R. Wickremasinghe, N. de Silv, N. K. Gunawardena, A. Pathmeswaran, R. Premaratna, L. Savioli, D. G. Lalloo and H. J. de Silva, “Estimating the Global Burden of Snakebite: A Literature Analysis and Modelling Based on Regional Estimates of Envenoming and Deaths,” PLoS Medicine, Vol. 5, No. 11, 2008, p. e218. doi:10.1371/journal.pmed.0050218
[4] D. I. Simpson and R. L. Norris, “Snakes of Medical Importance in India: Is the Concept of ‘Big 4’ Still Relevant and Useful?” Wilderness and Environmental Medicine, Vol. 18, No. 1, 2007, pp. 2-9. doi:10.1580/06-WEME-CO-023R1.1
[5] A. P. Premawardena, S. L. Seneviratne, S. B. Gunatilake and H. J. De Silva, “Excessive Fibrinolysis: The Coagulopathy Following Merrem’s Hump-Nosed Viper (Hypnale hypnale) Bites,” American Journal of Tropical Medicine and Hygiene, Vol. 58, No. 6, 1998, pp. 821-823.
[6] A. De Silva, A. S. B.Wijekoon and L. Jayasena, “Haemostatic Dysfunction and Acute Renal Failure Following Envenoming by Merrem’s Hump-Nosed Viper (Hypnale hypnale) in Sri Lanka: The First Authenticated Case,” Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol. 88, No. 2, 1994, pp. 209-212. doi:10.1016/0035-9203(94)90301-8
[7] A. Premawardena, S. L. Seneviratne, S. Jayanthi, S. B. Gunathilake and H. J. de Silva, “Coagulopathy and Fibrinolysis Following the Bite of a Hump-Nosed Viper (Hypnale hypnale),” Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol. 90, 1996, pp. 290-293.
[8] J. K. Joseph, I. D. Simpson, N. C. S. Menon, M. P. Jose, K. J. Kulkarni, G. B. Raghavendra and D. A. Warrell, “First Authenticated Cases of Life-Threatening Envenoming by the Hump-Nosed Pitviper (Hypnale hypnale) in India,” Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol. 101, No. 1, 2007, pp. 85-90. doi:10.1016/j.trstmh.2006.03.008
[9] H. J. de Silva, M. M. D. Fonseka, S. B. Gunatilake, S. A. M. Kularatne and K. H. Sellahewa, “Anti-Venom for Snakebite in Sri Lanka: We Need an Effective, Low Reactogenic, Affordable and Polyvalent AVS,” Ceylon Medical Journal, Vol. 40, 2002, pp. 43-45.
[10] C. A. Ariaratnam, V. Thuraisingam, S. A. M. Kularatne, M. H. R. Sheriff, R. D. G. Theakston, A. de Silva and D. A. Warrell, “Frequent and Potentially Fatal Envenoming by Hump-Nosed Pit Vipers (Hypnale hypnale and H. nepa) in Sri Lanka: Lack of Effective Antivenom,” Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol. 102, No. 11, 2008, pp. 1120-1126.
[11] I. B. Gawarammana and D. E. Keyler, “Dealing with Adverse Reactions to Snake Antivenom,” The Ceylon Medical Journal, Vol. 56, No. 3, 2011, pp. 87-90.
[12] K. H. Sellahewa, G. Gunawarden and M. P. Kumararathne, “Efficacy of Antivenom in the Treatment of Severe Local Envenomation by the Hump-Nosed Viper (Hypnale hypnale),” American Journal of Tropical Medicine and Hygiene, Vol. 53, No. 3, 1995, pp. 260-262.
[13] K. H. Sellahewa and M. P. Kumararatne, “Envenomation by the Hump-Nosed Viper (Hypnalehypnale),” American Journal of Tropical Medicine and Hygiene, Vol. 51, No. 6, 1994, pp. 823-825.
[14] A. De Silva, A. S. B. Wijekoon and L. Jayasena, “Haemostatic Dysfunction and Acute Renal Failure Following Envenoming by Merrem’s Hump-Nosed Viper (Hypnale hypnale) in Sri Lanka: The First Authenticated Case,” Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol. 88, No. 2, 1994, pp. 209-212. doi:10.1016/0035-9203(94)90301-8
[15] K. Maduwage, K. Kularatne, A. Wazil and I. Gawarammana, “Coagulopthy, Acute Kidney Injury and Death Following Hypnale Zaraenvenoming—The First Case Report from Sri Lanka,” Toxicon, Vol. 58, No. 8, 2011, pp. 641-643. doi:10.1016/j.toxicon.2011.09.014
[16] T. Varagunam and R. G. Panabokke, “Bilateral Necrosis of the Kidneys Following Snakebite,” Postgraduate Medical Journal, Vol. 46, 1970, pp. 449-451. doi:10.1136/pgmj.46.537.449
[17] L. Dharmaratne and U. Gunawardena, “Generalised Bleeding Tendency and Acute Renal Failure Following Merrem’s Hump-Nosed Viper Bite,” Journal of Ceylon College Physicians, 1989, pp. 21-22.
[18] H. Karunatilake, T. Nayakarathna, S. atapattu, T. Saparamadu and S. Dharmasena, “Thrombotic Microangiopathy and Fibrinolysis after Hump Nosed Viper Envenomation,” Ceylon Medical Journal, Vol. 57, No. 1, 2012, pp. 45-46. doi:10.4038/cmj.v57i1.4204
[19] N. Herath, A. Wazil, S. Kularatne, N. Ratnatunga, K. Weerakoon, S. Badurdeen, P. Rajakrishna, N. Nanayakkara and D. Dharmagunawardane, “Thrombotic Microangiopathy and Acute Kidney Injury in Hump-Nosedviper (Hypnale species) Envenoming: A Descriptive Study in Sri Lanka,” Toxicon, Vol. 60, No. 1, 2012, pp. 61-65. doi:10.1016/j.toxicon.2012.03.015
[20] M. Gunatilake, R. L. Jayakody, P. Angunawela and A. de Tissera, “Direct Nephrotoxic Effects Produced by Venoms of Sri Lankan Cobra, Russell’s Viperand Hump Nosed Viper,” The Ceylon Journal of Medical Science, 46, 2003, pp. 61-66.
[21] C. H. Tan, P. K. Leong, S. Y. Fung, S. M. Sim, G. Ponnudurai, C. Ariaratnam, S. Khomvilai, V. Sitprija and N. H. Tan, “Cross Neutralization of Hypnale hypnale (Hump-Nosed Pit Viper) Venom by Polyvalent and Monovalent Malayan Pit Viper Antivenoms in Vitro and in Arodent Model,” Acta Tropica, Vol. 117, No. 2, 2011, pp. 119-124. doi:10.1016/j.actatropica.2010.11.001

  
comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.