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Severe Viperidae envenomation complicated by a state of shock, acute kidney injury, and gangrene presenting late at the emergency department: a case report

BACKGROUND: Snake envenomation is an underestimated pathology in sub-Saharan Africa associated with severe emergencies, and even death in case of late presentation. We herein present a case of severe envenomation managed at the surgical emergency department of the Yaoundé Central Hospital. CASE PRES...

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Autores principales: Esiéné, Agnès, Etoundi, Paul Owono, Tochie, Joel Noutakdie, Metogo, Arlette Junette Mbengono, Minkande, Jacqueline Ze
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419359/
https://www.ncbi.nlm.nih.gov/pubmed/30871512
http://dx.doi.org/10.1186/s12873-019-0239-0
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author Esiéné, Agnès
Etoundi, Paul Owono
Tochie, Joel Noutakdie
Metogo, Arlette Junette Mbengono
Minkande, Jacqueline Ze
author_facet Esiéné, Agnès
Etoundi, Paul Owono
Tochie, Joel Noutakdie
Metogo, Arlette Junette Mbengono
Minkande, Jacqueline Ze
author_sort Esiéné, Agnès
collection PubMed
description BACKGROUND: Snake envenomation is an underestimated pathology in sub-Saharan Africa associated with severe emergencies, and even death in case of late presentation. We herein present a case of severe envenomation managed at the surgical emergency department of the Yaoundé Central Hospital. CASE PRESENTATION: We report a case of a 47-year-old female farmer with no relevant past history who sustained a snakebite by an Echis occellatus viper during an agricultural activity. Her initial management consisted in visiting a traditional healer who administered her some herbal remedies orally and applied a white balm on the affected limb. Due to progressive deterioration of her condition, she was rushed to our surgical department where she arrived 20 h after the snakebite incident. On admission she presented in a state of shock (suggestive of an anaphylactic shock), coagulopathy, renal impairment, and gangrene of the entire right upper limb. Emergency management consisted of fluid resuscitation, repeated boluses of adrenaline, a total of three vials of polyvalent anti-venom sera, promethazine, analgesics, corticosteroids, and administration of fresh frozen plasma. Within four hours of emergency department hospitalisation she developped signs of sepsis and persistent hypotension refractory to fluid resuscitation, suggestive of an associated septic shock. Management pursued with antiobiotherapy and administration of noradrenaline through an electric pump syringe to achieve a mean arterial blood pressure above 65 mmHg. The patient deceased at the 10th hour of hospitalisation in a state of circulatory collapse unresponsive to vasopressors, coagulopathy, renal failure, sepsis and gangrene of the right forearm. CONCLUSION: The authors highlight this unusual presentation but equally pinpoint how late presentation to the emergency department, harmful tradition practices, poverty and cultural beliefs can adversely affect the prognosis of snakebite in our setting.
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spelling pubmed-64193592019-03-27 Severe Viperidae envenomation complicated by a state of shock, acute kidney injury, and gangrene presenting late at the emergency department: a case report Esiéné, Agnès Etoundi, Paul Owono Tochie, Joel Noutakdie Metogo, Arlette Junette Mbengono Minkande, Jacqueline Ze BMC Emerg Med Case Report BACKGROUND: Snake envenomation is an underestimated pathology in sub-Saharan Africa associated with severe emergencies, and even death in case of late presentation. We herein present a case of severe envenomation managed at the surgical emergency department of the Yaoundé Central Hospital. CASE PRESENTATION: We report a case of a 47-year-old female farmer with no relevant past history who sustained a snakebite by an Echis occellatus viper during an agricultural activity. Her initial management consisted in visiting a traditional healer who administered her some herbal remedies orally and applied a white balm on the affected limb. Due to progressive deterioration of her condition, she was rushed to our surgical department where she arrived 20 h after the snakebite incident. On admission she presented in a state of shock (suggestive of an anaphylactic shock), coagulopathy, renal impairment, and gangrene of the entire right upper limb. Emergency management consisted of fluid resuscitation, repeated boluses of adrenaline, a total of three vials of polyvalent anti-venom sera, promethazine, analgesics, corticosteroids, and administration of fresh frozen plasma. Within four hours of emergency department hospitalisation she developped signs of sepsis and persistent hypotension refractory to fluid resuscitation, suggestive of an associated septic shock. Management pursued with antiobiotherapy and administration of noradrenaline through an electric pump syringe to achieve a mean arterial blood pressure above 65 mmHg. The patient deceased at the 10th hour of hospitalisation in a state of circulatory collapse unresponsive to vasopressors, coagulopathy, renal failure, sepsis and gangrene of the right forearm. CONCLUSION: The authors highlight this unusual presentation but equally pinpoint how late presentation to the emergency department, harmful tradition practices, poverty and cultural beliefs can adversely affect the prognosis of snakebite in our setting. BioMed Central 2019-03-12 /pmc/articles/PMC6419359/ /pubmed/30871512 http://dx.doi.org/10.1186/s12873-019-0239-0 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Esiéné, Agnès
Etoundi, Paul Owono
Tochie, Joel Noutakdie
Metogo, Arlette Junette Mbengono
Minkande, Jacqueline Ze
Severe Viperidae envenomation complicated by a state of shock, acute kidney injury, and gangrene presenting late at the emergency department: a case report
title Severe Viperidae envenomation complicated by a state of shock, acute kidney injury, and gangrene presenting late at the emergency department: a case report
title_full Severe Viperidae envenomation complicated by a state of shock, acute kidney injury, and gangrene presenting late at the emergency department: a case report
title_fullStr Severe Viperidae envenomation complicated by a state of shock, acute kidney injury, and gangrene presenting late at the emergency department: a case report
title_full_unstemmed Severe Viperidae envenomation complicated by a state of shock, acute kidney injury, and gangrene presenting late at the emergency department: a case report
title_short Severe Viperidae envenomation complicated by a state of shock, acute kidney injury, and gangrene presenting late at the emergency department: a case report
title_sort severe viperidae envenomation complicated by a state of shock, acute kidney injury, and gangrene presenting late at the emergency department: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419359/
https://www.ncbi.nlm.nih.gov/pubmed/30871512
http://dx.doi.org/10.1186/s12873-019-0239-0
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