COBRA BITE - LIVER PROBLEMS

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COBRA BITE - LIVER PROBLEMS

Postby Pelamis » Thu Dec 22, 2011 11:22 am

Firstly: Please note that this post and information contained herein, is posted with the permission of the child's mother.

Some of you may already know about this case.

Last night, I received a call from a friend informing me about a 5 year old girl that got bitten in her bed on Monday (19/12/2011) by what sounds like a Mozambique Spitting cobra (I did not see the snake myself).

This morning I visited the patient and spoke to her mother. The child got bitten on the left middle finger and on the elbow area. The left arm was elevated and she was connected to machines monitoring her vital data and oxygen was administered via oxygen mask. According to the mother, the child's skin colour turned yellow yesterday and this morning on the front page of the Beeld newspaper, it was visible. On my visit this morning, the yellow colour according to her mother seemed to have decreased. Two of her liver functions showed abnormal results indicating that the liver is being affected. From all the Mozambique Spitting cobra bites I have attended / seen, this is the first time that I have seen this happening. A short while ago, I also spoke to Bushviper about this case (which he also knows about).

Like I said to BV, that if he reads this post, he must please correct if I said something wrong and also I (personally) would like to know if anyone else dealing with snakebites have ever came across something like that. I know that snakes' venom may be more potent (toxic) in different areas and like he also said, everyday we learn something new about snakes' venom and their bites. Well, today was my turn!!

One good thing though at this stage is that since Monday up and until this morning that I left the hospital, no cuts, debridements or fasciotomies were performed which on that side is a good beginning I think.
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Re: COBRA BITE - LIVER PROBLEMS

Postby Sico » Thu Dec 22, 2011 11:48 am

As I mentioned on another thread, every single one of us will respond differently to the same bite due to a number of reasons.
The "jaundiced" colour of the child's skin is most likely related to a build up of the pigment billirubin, which is normally contained in the red blood cells. When heamolysis, or the break down of red blood cells occur (which is a normal process as they are constantly being broken down and regenerated in healthy people) the liver would filter out this pigment, which is then simply put excreted via the urine and the stool. When the liver cannot cope with this process, either due to a fault in the liver, or an inability of the liver to cope with the amount of red blood cells being broken down, the billirubin pigment shows up in the sclera and skin.
In this particular case, whether the jaundice was caused by the venom affecting the liver's function, or whether it was as a result of relatively significant heamolysis would be difficult to say without seeing the patient's complete blood workup. I would tend to think that the latter cause is the more likely one for the jaundice, rather than some type of "liver failure".
Normally when there is heamolysis going on, it will show up in urine tests, where you will see increased levels of urobillirubin and urobilinogen. If you could get a copy of the blood and urine analyses, and scan and post them, it would make it easier to determine where the problem was more likely to be.
With my D.viridis bite, I also displayed a fair amount of heamolysis evident in my urinalysis, but I did not develop any jaundice or other symptoms. I am sure that there exists in many venoms a signifcant amount of some or other protein or enzyme that destroys blood cells along with other cellular components and that is the cause of this. We do know that no venom is purely neuro/cyto/heamotoxic, and that there are components in all three that will affect all three systems simultaneously, aside from the Predominant effect.
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Re: COBRA BITE - LIVER PROBLEMS

Postby Bushviper » Thu Dec 22, 2011 12:25 pm

The urine analysis did not show any major discrepancies. The child has been transferred and getting the data will possibly not be easy any more.

I have asked that they hold off on debridements for another day or two as I dont believe she will lose the finger. From what I have been told the bottom of the finger is still pink and this gives me hope. Apparently she only got two vials of antivenom. Such a pity she could not have received at least five times as much.

I have not seen this jaundiced look myself but I do know the liver function results on a stiletto bite were way off the charts.
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Re: COBRA BITE - LIVER PROBLEMS

Postby Sico » Thu Dec 22, 2011 12:30 pm

It would be nice if there was a way of collating all the data from the bites we are seeing. If it was centralised, and if the Docs were prepared to fill out some kind of standard form, we could be learning so much from these cases.
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Re: COBRA BITE - LIVER PROBLEMS

Postby Bushviper » Thu Dec 22, 2011 12:51 pm

Sico you are so right. If the data base was accessible to doctors then that could help in future treatments too.
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Re: COBRA BITE - LIVER PROBLEMS

Postby Rodis » Thu Dec 22, 2011 12:59 pm

Let’s hope the little one pulls though without any amputations or debridgments. All the best to her and her family.

Mods this will be a double post, if deemed inappropriate please remove it as I am also posting this in the Thread- Dawin Awards.

To my own mind I have also put the free handling issue to bed. I have never hated free handling, although I don’t like it nor do I agree with it. But everyone to his own. And that’s why I was keen to see everyone’s point of view.

But after reading this article on News24 and then reading the comments, I had a light bulb moment.
Some of the comments are so ridicules and what makes it sadder is those who are commenting believe what they saying.

Here are some Gems “ A spitting cobra spits"!

Another - “But Lephalale is far from Mozambique. How did the snake get there? Something is not right here. Aren't snakes supposed to be child friendly? I remember seeing a video clip of a cobra pushing a toddler away instead if biting her. Or maybe this one was caught off guard and the only defence mechanism was to bite. Someone clarify me. "

And this was my final conclusion- All of us that love and keep reptiles have a responsibility to educate those who don’t and the general public. We need to expose the myths, the fallacies and the dam right ridicules. Pictures and videos of individual’s free handling create incorrect perceptions. Others have said so. I now agree. We may know that what you holding are potentially dangerous, but would the lady above know that? I doubt it. We have a much larger role to play. Most of us have embraced that role, its time we all do.
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Re: COBRA BITE - LIVER PROBLEMS

Postby taiwanbeauty » Thu Dec 22, 2011 1:17 pm

"Aren't snakes supposed to be child friendly?"
No snake in the world is child friendly, it can't identify between a child and an adult.
Both are equally a danger to the snake, and if it feels threatened it will bite.
IN THE BIBLE GOD GIVES US PERMISSION TO TREAD ON A SNAKES HEAD, ALL I CAN SAY IS “ PLEASE WATCH YOUR STEP”.
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Re: COBRA BITE - LIVER PROBLEMS

Postby Bushviper » Thu Dec 22, 2011 6:57 pm

The last bit of info I have been given is that they are raising funds to operate on the child. This despite all the advice from people who know about snake bites and have no vested interest in making money from operations. I suspect the child will have lost a finger by this time next week. What is sad is that the father is now the kids hero for killing the snake. I live 7 minutes drive from this hospital and have offered advice.

I am saddened by the fact that despite all the educational work, talks, books and courses having been made available to the public and the medical fraternity we still have archaic treatment being administered.

You have to know when to hold and when to fold. I had a pair of 2's so will fold on this hand.
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Re: COBRA BITE - LIVER PROBLEMS

Postby Pezulu » Thu Dec 22, 2011 9:10 pm

There was a talkshow program today on Talk Radio 702, where Mike Perry was the guest.
I only managed to catch a short portion of the show, but from what I heard I was unfortunately not very impressed.

The host asked Mike why a tourniquet must not be put on, and why a person should not try and "suck out the poison."
Mike replied that a tourniquet should be applied, and when one realises that the bite was not from a Black Mamba, to remove the tourniquet.
A person will know that the bite is from a Mamba, and not a Puff Adder, Night Adder, Stilletto Adder or Spitting Cobra, as the bite location will not bleed, will not show signs of swelling, and there won't be much pain.

I may be wrong, but in my mind this is misinforming the general public, as a tag from a Brown House Snake will often bleed, and there will often be a "sting" associated with the bite.
A Herold Snake has proportionately large fangs, which it uses to puncture and deflate its primary prey, the toad. A bit from that snake will be painful and bleed quite a bit, but the persons life will not be in danger.
The Herold Snake also looks similar to a Mamba, in that it is blackish, which is the popular misconception on the colour of Dendroaspis Polylepis.
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Re: COBRA BITE - LIVER PROBLEMS

Postby Bushviper » Fri Dec 23, 2011 8:41 am

The report in todays newspaper indicates that the little girl has taken a turn for the worst. Family are being phoned and it looks as if they do not expect her to make it. This is really sad but I expect her to pull through. The doctors working on her do not seem to have too much experience with snake bites. At least they are not going to operate on her hand at this stage which is a possibly a blessing in disguise.

Medical expenses already R40 000-00 minimum and the right amount of antivenom would only have been R7500-00. I have no answers and can only shake my head in anger and disappointment.
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Re: COBRA BITE - LIVER PROBLEMS

Postby Smeegle » Sun Dec 25, 2011 7:27 pm

That is just so sad. I was chatting to two friends of my sister-in-law yesterday, they are qualified doctors at state hospitals.

They both concurred that they "wouldn't have a clue how to treat a snake bite"....
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Re: COBRA BITE - LIVER PROBLEMS

Postby Bushviper » Mon Dec 26, 2011 1:18 pm

This little girl seems to be a fighter. She is exercising using a stress ball which should convince the surgeons that they should not amputate her finger. The operation to clean off the dead skin and tissue (debridement) is scheduled for Wednesday. She will take a long time to heal but I think she will be okay. Possibly I can go see her this afternoon and take some pictures.
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Re: COBRA BITE - LIVER PROBLEMS

Postby Shamrock » Mon Dec 26, 2011 3:39 pm

I'm glad to her its going better with her, I hope she recovers well.
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Re: COBRA BITE - LIVER PROBLEMS

Postby Rob Macmillan » Tue Dec 27, 2011 12:37 am

BV, why has nothing been circulated around the medical fraternity by the likes of Dr Blaylock and Dr Wood? Those are two highly specialized doctors who work alot with bites up in the Zululand area. Majority of those bites comprise of Mfezi and Puff Adder bites..... It bugs me that we do have experts in this field yet very few Doctors listen to the more advanced advice given. Is this a case of "Farting against thunder"????
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