Cargando…

Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literature

The black mamba (Dendroaspis polylepis) ranks consistently as one of the most revered snakes in sub-Saharan Africa. It has potent neurotoxic venom, and envenomation results in rapid onset and severe clinical manifestations. This report describes the clinical course and reversal of effects of black m...

Descripción completa

Detalles Bibliográficos
Autores principales: Erulu, Valentine Eugene, Okumu, Mitchel Otieno, Ochola, Francis Okumu, Gikunju, Joseph Kangangi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6161185/
https://www.ncbi.nlm.nih.gov/pubmed/30274500
http://dx.doi.org/10.3390/tropicalmed3030104
_version_ 1783358935403593728
author Erulu, Valentine Eugene
Okumu, Mitchel Otieno
Ochola, Francis Okumu
Gikunju, Joseph Kangangi
author_facet Erulu, Valentine Eugene
Okumu, Mitchel Otieno
Ochola, Francis Okumu
Gikunju, Joseph Kangangi
author_sort Erulu, Valentine Eugene
collection PubMed
description The black mamba (Dendroaspis polylepis) ranks consistently as one of the most revered snakes in sub-Saharan Africa. It has potent neurotoxic venom, and envenomation results in rapid onset and severe clinical manifestations. This report describes the clinical course and reversal of effects of black mamba envenomation in a 13-year-old boy in the Jimba area of Malindi. The victim presented to Watamu Hospital, a low resource health facility with labored breathing, frothing at the mouth, severe ptosis and pupils non-responsive to light. His blood pressure was unrecordable, heart rate was 100 beats per minute but thready, his temperature was 35.5 °C, and oxygen saturation was 83%. Management involved suction to clear salivary secretions, several hours of mechanical ventilation via ambu-bagging, oxygen saturation monitoring, and the use of South African Vaccine Producers (SAVP) polyvalent antivenom. Subcutaneous adrenaline was used to stave off anaphylaxis. The victim went into cardiac arrest on two occasions and chest compressions lasting 3–5 min was used to complement artificial ventilation. Hemodynamic instability was corrected using IV infusion of ringers lactate and normal saline (three liters over 24 h). Adequate mechanical ventilation and the use of specific antivenom remain key in the management of black mamba envenomation.
format Online
Article
Text
id pubmed-6161185
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-61611852018-10-01 Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literature Erulu, Valentine Eugene Okumu, Mitchel Otieno Ochola, Francis Okumu Gikunju, Joseph Kangangi Trop Med Infect Dis Case Report The black mamba (Dendroaspis polylepis) ranks consistently as one of the most revered snakes in sub-Saharan Africa. It has potent neurotoxic venom, and envenomation results in rapid onset and severe clinical manifestations. This report describes the clinical course and reversal of effects of black mamba envenomation in a 13-year-old boy in the Jimba area of Malindi. The victim presented to Watamu Hospital, a low resource health facility with labored breathing, frothing at the mouth, severe ptosis and pupils non-responsive to light. His blood pressure was unrecordable, heart rate was 100 beats per minute but thready, his temperature was 35.5 °C, and oxygen saturation was 83%. Management involved suction to clear salivary secretions, several hours of mechanical ventilation via ambu-bagging, oxygen saturation monitoring, and the use of South African Vaccine Producers (SAVP) polyvalent antivenom. Subcutaneous adrenaline was used to stave off anaphylaxis. The victim went into cardiac arrest on two occasions and chest compressions lasting 3–5 min was used to complement artificial ventilation. Hemodynamic instability was corrected using IV infusion of ringers lactate and normal saline (three liters over 24 h). Adequate mechanical ventilation and the use of specific antivenom remain key in the management of black mamba envenomation. MDPI 2018-09-19 /pmc/articles/PMC6161185/ /pubmed/30274500 http://dx.doi.org/10.3390/tropicalmed3030104 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Erulu, Valentine Eugene
Okumu, Mitchel Otieno
Ochola, Francis Okumu
Gikunju, Joseph Kangangi
Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literature
title Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literature
title_full Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literature
title_fullStr Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literature
title_full_unstemmed Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literature
title_short Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literature
title_sort revered but poorly understood: a case report of dendroaspis polylepis (black mamba) envenomation in watamu, malindi kenya, and a review of the literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6161185/
https://www.ncbi.nlm.nih.gov/pubmed/30274500
http://dx.doi.org/10.3390/tropicalmed3030104
work_keys_str_mv AT eruluvalentineeugene reveredbutpoorlyunderstoodacasereportofdendroaspispolylepisblackmambaenvenomationinwatamumalindikenyaandareviewoftheliterature
AT okumumitchelotieno reveredbutpoorlyunderstoodacasereportofdendroaspispolylepisblackmambaenvenomationinwatamumalindikenyaandareviewoftheliterature
AT ocholafrancisokumu reveredbutpoorlyunderstoodacasereportofdendroaspispolylepisblackmambaenvenomationinwatamumalindikenyaandareviewoftheliterature
AT gikunjujosephkangangi reveredbutpoorlyunderstoodacasereportofdendroaspispolylepisblackmambaenvenomationinwatamumalindikenyaandareviewoftheliterature